The  Diseases  of  the  Genital  Organs 
of  Domestic  Animals 


W.  L.  WILLIAMS 


PROFESSOR  OF  OBSTETRICS  AND  RESEARCH  PROFESSOR 

IN  THE  DISEASES  OF  BREEDING  CATTLE 

IN   THE 

NEW  YORK  STATE  VETERINARY  COLLEGE  AT  CORNELL  UNIVERSITY 


WITH  THE  COLLABORATION  OF 

W.  W.  WILLIAMS,  B.A.,  D.V.M. 

SPRINGFIELD,  MASS. 


Published  by  the  Author 
ITHACA,  N.  Y. 

1921 


(BIOLOGY 

PJBRARV 
6 


Copyright  by 
W.  L.  WILLIAMS 

1921 


Press  of 

ANDRUS  &  CHURCH 

Ithaca.  N.  Y. 


PREFACE 

No  attempt  has  been  made  heretofore  to  describe  system- 
atically the  genital  diseases  of  domestic  animals.  The  path- 
ologic processes  acting  within  the  genital  organs  and  inter- 
fering with  the  ideal  production  of  young  are  chiefly  hidden 
from  view.  Only  certain  phenomena  caused  by  them  be- 
come apparent.  Of  these  the  most  striking  phenomenon  is 
the  observed  expulsion  of  a  fetal  cadaver,  which  is  desig- 
nated abortion.  The  observer  is  generally  forewarned  of 
impending  death  of  a  born  animal  because  it  is  commonly 
preceded  by  visible  injury  or  illness,  but  abortion  produces 
a  profound  impression  because  the  death  of  a  potentially 
valuable  unborn  animal  has  occurred  unseen  and  is  re- 
vealed only  when  the  cadaver  is  seen  to  be  expelled.  This 
tends  to  draw  a  veil  of  mystery  about  the  event.  If  the 
spermatozoon,  unfertilized  or  fertilized  ovum,  or  the  small 
embryo  perishes,  the  dead  cell  or  body  is  not  observed  and 
therefore  excites  little  or  no  comment. 

In  the  early  history  of  medicine,  certain  striking  phe- 
nomena were  regarded  and  described  as  diseases.  When  the 
science  of  pathology  became  established,  a  rearrangement 
of  medical  literature  became  necessary  and  the  phenomena 
became  grouped  about  their  causes,  so  far  as  known.  It 
followed  that  various  phenomena  which  had  been  regarded 
as  distinct  diseases  were  in  some  cases  due  to  a  common 
cause.  In  other  cases  a  phenomenon  classed  as  a  disease 
has  been  split  up  because  the  phenomenon  was  inconstant 
in  its  cause.  In  primitive  veterinary  literature  glanders  and 
farcy  were  described  as  distinct  aff'ections,  but  later  it  be- 
came known  that  the  two  supposed  diseases  were  merely 
separate  phenomena  resulting  from  one  cause.  Nasal  gleet 
occupied  a  prominent  place  in  primitive  veterinary  litera- 
ture, but  as  veterinary  science  advanced  the  phenomenon  of 
nasal  discharge  was  split  up,  assigned  in  each  case  to  the 
disease  of  which  it  constituted  one  symptom,  and  nasal  gleet 
disappeared  from  the  pages  of  veterinary  literature. 


iv  Preface 

The  pathologic  processes  occurring  in  the  genitalia  of 
animals  have  been  almost  wholly  described  under  the  primi- 
tive method,  each  striking  phe^iomenon  being  elevated  to 
the  dignity  of  a  disease.  Consequently  a  certain  infection, 
by  causing  a  wide  variety  of  outstanding  phenomena,  in- 
jected into  veterinary  literature  numerous  alleged  "dis- 
eases" each  due  to  a  single  infection.  It  was  unavoidable 
also  that  a  given  phenomenon,  such  as  fetal  death,  which 
may  be  due  to  numerous  different  infecting  agents,  should 
be  known  as  one  disease.  Thus  abortion,  metritis,  retained 
fetal  membranes,  epididymitis,  semino-vesiculitis,  and  dys- 
entery of  the  new-born,  all  of  which  in  a  given  series  of 
cases  may  be  due  to  an  identical  infection,  have  been  de- 
scribed as  six  distinct  diseases  and  scattered  from  end  to  end 
of  veterinary  literature. 

The  re-casting  of  the  genital  diseases  of  animals  into  a 
systematic  treatise  is  a  formidable  task,  the  first  effort  at 
which  must  be  very  imperfect.  In  1909  I  published  "Vet- 
erinary Obstetrics;  Including  the  Diseases  of  Breed- 
ing Animals  and  of  the  New  Born",  in  which  many  of 
the  diseases  of  the  genital  organs  were  included  under  the 
primitive  plan.  It  was  abandoned  at  the  exhaustion  of  the 
first  edition.  In  1917  I  published  "Veterinary  Obstet- 
rics" and  began  the  preparation  of  the  present  volume.  The 
two  treatises  have  been  designated  "companion  volumes" 
because  they  are  closely  allied  in  subject  matter  and  may  be 
profitably  studied  together. 

The  present  treatise  appears  at  a  critical  period  in  the 
history  of  the  diseases  of  the  genital  organs  of  animals, 
when  an  old,  firmly  entrenched  belief  is  slowly  crumbling 
and  a  modern  one  is  struggling  for  recognition.  Abortion 
has  long  been  regarded  as  a  specific  infectious  disease,  due 
in  a  given  species  of  animals  to  one  bacterium  and  to  one 
only.  If  an  exception  arose  and  a  given  abortion  or  group 
of  abortions  was  apparently  due  to  an  infection  other  than 
that  specified  for  the  species  of  animal  concerned,  it  was  not 
infectious  abortion  but  merely  abortion  due  to  infection. 

The  belief  in  a  specific  infectious  abortion  has  occupied 


Preface  v 

the  central  position  in  the  literature  upon  genital  diseases 
in  animals  so  long,  that  anyone  attempting  to  write  a  sys- 
tematic treatise  in  this  field  must  either  make  infectious 
abortion  the  cornerstone  or  reject  it  wholly.  While  in  this 
treatise  it  is  held  that  all  abortions  in  animals  (except  those 
induced  surgically)  are  due  to  infection,  it  is  denied  that 
such  infection  is  specific,  as  that  term  is  commonly  under- 
stood in  medicine.  It  is  denied  as  a  principle  in  pathology 
that  conception,  parturition,  birth,  or  other  physiologic  act 
draws  across  the  path  of  life  an  impenetrable  barrier  to  dis- 
ease. It  is  held  that  any  infection  competent  to  invade  a 
female  may  likewise  invade  a  male;  if  able  to  invade  a  preg- 
nant animal,  it  may  also  invade  the  same  animal  when  non- 
pregnant ;  if  it  can  gain  a  habitat  in  the  pregnant  female,  it 
may  persist  after  parturition ;  if  it  can  invade  and  imperil 
the  life  of  an  embryo  or  fetus,  it  may  continue  through 
birth  and  aifect  the  new-born,  or  may  attack  the  new-born 
from  external  sources.  Any  infection  which  can  invade  and 
injure  or  kill  a  post-natal  animal,  may  cause  the  same  in- 
jury to  it  while  intra-uterine,  provided  that  contact  is  made. 
If  tuberculosis  or  syphilis  exists  in  the  pregnant  uterus,  the 
infection  may  invade  the  embryo.  There  is  no  evidence  to 
show,  and  no  reason  to  believe,  that  any  acute  infection  may 
not  attack  and  destroy  the  embryo  if  the  virus  is  brought 
into  contact  with  it.  It  is  true  that  acute  infections,  when 
attacking  a  pregnant  female,  rarely  if  ever  pass  the  intact 
placental  filter  and  reach  the  embryo.  It  does  not  follow 
that  the  embryo  is  immune  to  the  infection,  but  merely  that 
it  is  in  a  hermetically  sealed  sac,  so  isolated  that  the  virus 
fails  to  acquire  contact. 

Although  the  placental  isolation  of  the  embryo  is  efficient 
against  filterable  viruses,  the  supporters  of  the  "specific  in- 
fectious abortion"  theory  hold  that  certain  comparatively 
large  bacteria  defy  this  important  law,  invade  the  pregnant 
female,  pass  directly  to  the  existing  embryo,  and  cause  its 
death  and  expulsion.  But  in  invading  the  pregnant  female, 
presumably  through  the  mouth,  the  infection  is  alleged  to 
reach  the  endometrium  and  embryo  without  leaving  behind 


vi  Preface 

any  lesion  in  its  path  or  causing  any  disease  or  sign  of  dis- 
ease. 

This  treatise  is  built  upon  the  belief  that  abortion  is  only 
an  incident  in  the  ravages  of  infections  existing  within  the 
pregnant  uterus  at  the  date  of  conception,  or  deposited  with 
the  semen  at  coitus.  The  infection  is  not  specific,  is  not 
limited  to  one  species  of  bacterium,  invades  organs  other 
than  the  uterus,  and  involves  both  sexes  and  all  ages.  This 
general  infection  causes  a  long  list  of  phenomena  or  lesions. 
The  basic  conflict  of  view  with  the  majority  of  investiga- 
tors will  inevitably  draw  much  unfavorable  criticism.  In 
order  to  justify  the  views  stated,  controversial  matter  has 
been  included.  This  is  regretted  because  it  increases  the 
size  of  the  volume,  and  because  some  highly  esteemed  col- 
leagues may  erroneously  regard  such  statements  as  personal 
reflections. 

The  conflicting  views  have  served  to  delay  publication.  A 
belief  so  long  and  thoroughly  entrenched  as  that  of  specific 
infectious  abortion  can  not  be  overthrown  quickly.  Neither 
would  the  overthrow  of  what  I  believe  an  error  be  a  gain 
unless  a  foundation  were  ready  upon  which  a  more  valuable 
structure  could  be  erected.  I  made  the  first  open  attack 
upon  the  specific  infectious  abortion  theory  in  1912,  and  that 
has  been  followed  periodically  from  various  angles.  But 
external  attack  has  not  been  as  effective  as  internal  disinte- 
grating forces.  The  champions  of  a  specific  infectious  abor- 
tion have  admitted  that  at  least  several  different  species  of 
bacteria  may  and  do  cause  abortion  in  a  given  species  of 
animal,  and  that  the  lesions  caused  by  the  several  bacterial 
forms  are  not  difTerentiable  clinically  or  macroscopically. 
A  most  serious  drawback  to  the  theory  has  been  its  failure 
in  practical  application.  It  was  announced  twenty-five 
years  ago  that,  since  the  cause  of  infectious  abortion  had 
been  proven,  it  could  be  controlled.  The  twenty-five  years 
which  have  elapsed  have  seen  no  progress  in  the  control  of 
abortion  based  upon  the  specific  theory.  The  prevalence  of 
abortion  is  greater  today  than  at  any  prior  date  in  history. 
During  the  past  decade  there  has  been  developing  gradu- 


Preface  vii 

ally  another  view  which  appears  more  logical,  is  in  harmony 
with  the  general  principles  of  pathology,  and  is  in  full  ac- 
cord with  all  data  recorded  by  the  believers  in  specific  in- 
fectious abortion.  That  portion  of  the  volume  designated 
"The  General  Genital  Infections"  must  be  regarded  as  the 
cornerstone ;  if  the  principles  it  has  been  attempted  to  estab- 
lish there  break  down,  it  fails  as  a  systematic  treatise.  The 
principles  which  it  is  attempted  to  establish  place  the  com- 
mon and  most  destructive  genital  infections  upon  a  plane 
analogous  to  wound  infection.  Various  bacteria  exist  in  the 
genitalia  of  both  sexes  of  all  ages  and  species.  The  virulence 
and  variety  vary  at  different  times  and  in  different  indi- 
viduals. They  are  modified  by  general  health,  coitus,  preg- 
nancy, parturition  and  other  critical  incidents  in  life. 

The  belief  in  a  specific  infectious  abortion  logically  de- 
mands for  the  control  of  the  disease  the  isolation  of  the 
pregnant  female  from  all  possible  carriers  of  infections ;  in 
this  treatise  it  is  held  that  physiologic  reproduction  is  based 
upon  coitus  between  two  sexually  healthy  animals.  The  first 
is  a  hypothesis  of  despair,  confirmed  by  lamentable  failure 
over  a  period  of  twenty-five  years :  the  latter  a  doctrine  of 
hope,  supported  by  success.  Before  publishing  this  treatise 
it  was  regarded  as  essential  that  the  principles  should  have 
been  tried  thoroughly  and  proven  successful  in  the  crucible 
of  practical  clinical  application.  This  has  been  a  difficult 
task  requiring  unbounded  and  infinite  patience  under  great 
discouragements  and  against  opposition. 

The  treatise  is  inevitably  very  imperfect  in  every  part, 
and  those  who  are  inclined  to  criticise  will  have  excellent 
opportunity.  But  the  volume  was  not  made  to  cause  or  to 
avoid  criticism.  It  is  a  first  effort  in  a  new  field  which,  it  is 
hoped,  may  be  helpful  to  some  and  which  may  serve  to 
awaken  a  new  interest  in  the  diseases  interfering  with  re- 
production in  animals.  The  call  of  the  hour  to  veterinarian 
and  breeder  is  for  increased  efficiency  of  each  domestic  ani- 
mal. The  room  for  animal  numbers  is  decreasing,  while  the 
demand  for  service  in  the  production  of  milk,  meat,  labor  or 
other  products   is   increasing.     Most   of  the  great  animal 


viii  Preface 

plagues  which  imperil  the  lives  of  adults  have  been  brought 
under  measurable  control,  but  those  infections  involving  the 
safety  of  the  embryo  are  constantly  gathering  force.  Yet  it 
must  be  remembered  that  the  sexual  health  of  those  animals 
desired  for  reproduction  is  the  first  basic  need  in  animal 
husbandry.  Reproductive  efficiency  in  purebred  cattle, 
swine,  and  horses,  so  far  as  can  be  estimated,  has  dropped 
below  60  per  cent,  of  the  ideal  and  continues  to  descend  at  a 
discouraging  pace.  The  condition  can  be  relieved  only 
through  conscientious  and  skillful  work  by  veterinarians 
and  breeders.  The  problem  is  difficult  and  the  duration  of 
the  task  infinite.  It  calls  for  the  adoption  of  a  permanent 
policy  of  guarding  sexual  health  in  animals — not  of  "cur- 
ing" established  lesions.  The  advancement  of  reproductive 
efficiency  in  the  best  animals  is  at  present  the  greatest  eco- 
nomic problem  in  veterinary  medicine. 

In  a  higher  realm  the  study  of  genital  diseases  in  domestic 
animals  may  be  made  of  incalculable  value  in  the  elucidation 
of  the  basic  principles  of  genital  diseases  in  man.  Aside 
from  the  specific  venereal  diseases  of  man,  the  genital  infec- 
tions are  probably  analogous  to,  and  possibly  identical  with, 
the  general  genital  infections  of  animals.  What  is  true  of 
the  intra-uterine  infections  of  the  embryo  in  domestic  ani- 
mals is  presumably  equally  true  in  principle  of  the  human 
embryo.  The  veterinarian  has  opportunities  for  the  study 
of  the  infections  of  the  genital  organs  and  embryos  of  ani- 
mals wholly  denied  to  practitioners  of  human  medicine.  The 
veterinarian  has  freely  available  in  the  abattoir  the  genitalia 
in  health  and  in  disease  of  thousands  and  millions  of  freshly 
slaughtered  cattle,  sheep,  and  swine  of  all  ages  and  of  both 
sexes.  The.  females  are  pregnant  and  non-pregnant  and  the 
embryos  are  of  all  ages,  diseased  and  healthy.  Clinically  the 
veterinarian  can  palpate  the  genital  organs  of  the  cow  and 
mare  freely  per  rectum  and  read  the  anatomical  lesions  of 
ovaries,  oviducts  and  uterus  as  the  blind  read  braille.  The 
fetus  can  be  manipulated,  its  movements  in  response  to  me- 
chanical stimulation  studied,  and  its  physiologic  function  of 
swallowing  its  amniotic  fluid  recognized. 


Preface  ix 

The  new-born  animal  can  be  studied  freely  regarding  the 
infections  carried  from  the  uterus,  can  be  fed  experimen- 
tally, and  may  be  destroyed  at  will  for  examination.  If  the 
veterinary  profession  is  fully  to  live  up  to  its  opportunities 
and  discharge  its  obligations  to  the  state,  it  must  contribute 
its  share  to  the  advancement  of  the  knowledge  of  disease. 
Nowhere  else  can  it  contribute  more,  nor  as  much,  of  value, 
as  in  the  basic  principles  of  the  physiology,  pathology  and 
hygiene  of  reproduction. 

Purely  a  clinician,  I  have  been  dependent  upon  others  for 
bacteriologic  and  histologic  facts.  In  this  field  Drs.  W.  A. 
Hagan  and  C.  M.  Carpenter  have  rendered  invaluable 
aid.  Working  first  in  my  department  and  later  in  the  de- 
partment of  pathology  and  bacteriology,  they  have  extended 
every  possible  assistance.  Similar  help  has  been  given  by 
Dr.  Herbert  L.  Gilman,  at  present  in  my  department.  The 
reader  should  undertsand  the  difficulty  of  securing  knowl- 
edge regarding  genital  infections  in  animals.  In  general 
bacteriologists  have  not  studied  the  genitalia  of  animals  for 
infections,  but  for  one  specific  infection,  and  have  left  un- 
recorded and  unstudied  all  others.  If  the  bacillus  thought 
by  the  investigator  to  be  the  cause  of  infectious  abortion  was 
recognized,  that  was  deemed  final  proof  of  it,  and  no  other, 
caused  the  disease.  Drs.  Hagan,  Carpenter,  and  Gilman 
have  so  far  as  practicable  studied  all  bacteria  found  in  the 
genital  organs  and  their  significance  in  the  problem  of  re- 
production. 

My  collaborator,  Dr.  W.  W.  Williams,  has  contributed 
greatly  to  the  value  of  the  treatise.  Having  devoted  his  en- 
tire energy  for  a  number  of  years  to  the  handling  of  genital 
diseases  and  the  advancement  of  reproductive  efliciency  in 
purebred  cattle,  he  has  demonstrated  with  unusual  clearness 
the  value  of  the  scientific  handling  of  this  group  of  infec- 
tions. He  has  contributed  especially  the  sections  upon  the 
surgery  of  the  cervix  and  the  genital  infections  of  bulls. 

W.  L.  Williams. 
Cornell  University 
Ithaca,  N.  Y. 
April,  1921 


TABLE  OF  CONTENTS 

PART  I 

DISEASES    AND    DEFECTS    NOT    ATTRIBUTABLE  TO 
INFECTION 

PAGE 

chapter  i 
thb:  anatomy  and  phYvSiology  of  the  genitalia    .  . 

The  Genital  Organs  of  the  Male ...  i 

The  Testicles  and  Their  Excretor}'  Ducts    ...■■"....  i 

The  Vesicula  Seminalis,  Prostate,  and  Cowper's  Glands    ...  lo 

The  Penis 14 

The  Sheath  and  Prepuce 15 

The  Genital  Organs  OF  THE  Female iS 

The  Ovaries 18 

The  Muellerian  Ducts 22 

The  Oviducts 25 

The  Uterus 26 

The  Cervix 33 

The  Vagina 36 

Gartner's  Ducts 39 

The  Vulva  ....            41 

The  Physiology  of  the  Genitalia     44 

The  Ripening  of  the  Ovisac  and  Ovum 44 

Estrum 47 

Ovulation 49 

Menstruation •    •    .    .    .  51 

The  Corpus  lyuteum  of  Estrum 52 

Copulation     ....            53 

The  Ejaculation  of  Semen 53 

The  Migration  of  Spermatozoa 54 

Fertilization 55 

The  Migration  and  Implantation  of  the  Ovum 55 

The  Corpus  Luteum  of  Pregnancy 56 

The  Fetal  Membranes 58 

CHAPTER  II 

THE  CLINICAL  EXAMINATION  OF  THE  GENITALIA 73 

The  Clinical  Examin.\tion  of  the  Male  Genitalia     ...  73 

The  Testicles 74 

The  Epididymis 75 

The  Seminal  Vesicles,  Prostate,  and  Cowper's  Glands    ....  76 

The  Semen  and  Spermatozoa 77 


xii  Co7itents 

The  Cunical  Examination  ok  the  Femai^e  Genitaija    ...  79 

The  Examination  of  Vulva  and  Vagina 84 

Rectal  Palpation Sg 

The  Examination  of  the  Cervical  Canal  and  Douching  of  the 

Uterus 99 

The  Diagnosis  OF  EsTRUM in 

The  Diagnosis  OF  Pregnancy 113 

CHAPTER  III 
ARTIFICIAL  INTERFERENCES  WITH  REPRODUCTIVE 

FUNCTIONS 140 

The  Induction  of  Estrum 140 

Artificiai,  Insemination 143 

Artificial  Abortion 146 

CHAPTER  IV 

ARRESTS  AND  ABERRATIONS  IN   GENITAL   DEVELOPMENT  151 

Asexual  or  Bisexuai,  Aberrations 151 

Neuters  or  Freemartins 151 

Hermaphroditism 157 

Arrests  in  the  Development  of  the  male  Genitalia     .   .   .  160 

Arrests  and  Aberrations  in  the  Development  of  the  Testes   .    .  160 

Cryptorchidy r6o 

Aberration  in  Position  of  Scrotal  Testes 161 

Arrest  in    Functional   Development   of   Scrotal   Testes,    Fetal 

Testes 161 

Aberrations  in  the  Development  of  the  Penis 163 

Congenital  Defects  of  the  Female  Genitalia 163 

Uterus  Unicornis 165 

Double  Uterus,  Double  Cervix 165 

Persistence  of  Median  Walls  of  Muellerian  Ducts  in  Vaginal 

Area,  Double  Vagina 167 

Imperforate  Hymen,  Persistent  Hymen 169 

CHAPTER  V 
MISCELLANEOUS    DEFECTS  AND    DISEASES    INTERFP:RING 

WITH  FERTILITY 172 

Umbilic  Hernia 172 

Ventral   Hernia i74 

Horizontal  Vulva i74 

Stricture  of  Vagina  and  Vulva i75 

Diseases  of  the  Feet  and  Limbs i77 

Paralysis,  Plumbism •    • 179 

Torsion  of  the  Testicle 180 

Traumatic  Orchitis 181 

Tubal    Pregnancy 185 

Vaginal  Hernia 185 

Torsion  of   the  Uterus 189 

Pelvic  Tumors  and  Calluses 19" 


Contents  xiii 

CHAPTER  VI 
SYSTEMIC     DISEASES     AND     DERANGEMENTS     INTERFERING 

WITH  REPRODUCTION 192 

Physical    Overwork ' 192 


Starvation 


'93 


Obesity 194 

Idleness  and  Overfeeding 196 

Sexual  Excess 200 

Onanism  or  Masturbation 203 

CHAPTER  VII 

COITAL  INJURIES 205 

Kicks  and  Fractures 206 

False  Copulation,  Rectal  Injuries  ...  210 

Laceration  and  Rupture  of  the  Vagina 214 

Coital  Rupture  of  the  Uterus 216 

Coital  Rupture  of  the  Urinary  Bladder 217 

Vaginal  Hemorrhage  following  Coitus 218 

Urethral  Hemorrhage  in  Stallion 218 

Contusions  of  Neck  and  Withers 219 

Penial   Injuries 219 

Rupture  of  Prepuce 223 

Strangulated  Hernia 225 

CHAPTER  VIII 

PARTURIENT   INJURIES 22S 

Lacerations  of  Perineum 228 

Recto- Vaginal  Fistula 229 

Lacerations  of    Cervix 229 

CHAPTER  IX 

SODOMY  AND  SADISM 231 

PART  II 

TUMORS  OF  THE  GENITALIA 

CHAPTER  X 

MALIGNANT  NEOPLASMS 239 

Malignant  Tumors  of  the  Male  Genitalia 239 

Amputation  of  the  Penis 245 

Malignant  New-Growths  of  the  Female  Genitalia 250 

CHAPTER  XI 

BENIGN  TUMORS  OF  THE  GENITALIA 253 

Benign  Tumors  of  the  Male  Genitalia 253 

Benign  Tumors  of  the  Female  Genitalia 257 

Ovariotomy ; 263 


xiv  Contents 

PART  III 

INFECTIONS  OF  THE  GENITAL  ORGANS 

SECTION  I.     THE  GENITAL  INFECTIONS  OF  CATTLE 
CHAPTER  XII 

THE  SPECIFIC  VENEREAL  DISEASES 278 

The  Vesicular  Venereal  Disease  of  Cattle 278 

The  Nodular  Venereal  Disease 283 

CHAPTER  XIII 
NON-VENEREAL  INFECTIONS  WHICH  INVADE  THE  GENITAL 

ORGANS 317 

Genital  Actinomycosis 317 

Genital  Tuberculosis 319 

CHAPTER  XIV 

THE  GENERAL  INFECTIONS  OF  THE  GENITAL  ORGANS  ...  356 

I.  INFECTIONS  OF  THE  GENITAL  ORGANS  OF  BULLS  .    .  35S 
Orchitis , 375 

Degenerative  Orchitis.     Destruction  of   Spermatogeuetic  Epi- 
thelium in  Calves 375 

Orchitis  in  Adult  Bulls.    Abscessation  and  Necrosis  of  Testicles  379 

Epididymitis • 3^5 

Degenerative  Epididymhis  of  Calves 385 

Arrest  in  Development  ...            385 

Chronic  Indurated  Epididymal  Abscesses  of  Calves 386 

Epididymitis  of  Adult  Bulls 388 

Infections  OF  THE  Glands  OF  THE  Pelvic  Urethra 389 

Spermato-Cystitis 3^9 

Diseases  of  Prostate  and  Cowper's  Glands 393 

Balantitis.    Balano-Posthitis.     "  The  Granular  Venereal 

Disease" 393 

II.  GENERAL  INFECTIONS  OF  THE  GENITAL  ORGANS  OF 

HEIFERS  AND   COWS 

Diseases  of  the  Ovaries.     Ovaritis 394 

Atretic  Follicles 395 

Cystic  Degeneration  of  the  Ovaries,  Nymphomania 395 

Intra-FoUicular  Hemorrhage 409 

Post-Ovulation  Hemorrhage  into  the  Follicular  Crater  .    .    .    .  411 

Hemorrhagic  Corpus  Luteum  .  412 

Cystic  Degeneration  of  the  Corpus  Luteum        413 

Hypertrophy  of  the  Corpus  Luteum       418 

Persistent  Corpus  Luteum 421 

Central  or  Embedded  Corpus  Luteum.     The  Corpus  Luteum  of 

Pvometra  and  of  Retained  Fetal  Cadaver 422 


Contents  xv 

Abscess  of   Ovary 424 

Corpora  Nigra       425 

Par-Ovarian  Cysts      425 

TrBAL  Infections       426 

Salpingitis,  Pavilionitis,  Adherent  Ovary 428 

Pyosalpinx.    Tubo-Ovarian  Abscesses      .        445 

Hydrosalpinx.     Dropsy  of  the  Pavilion 448 

Cysts  in  the  Mesosalpinx 452 

UTERINE  Infections 453 

The  Diseases  of  the  Uterus  of  the  Heifer  Calf  and  Virgin  Heifer  453 

Intra-Uterine  Infection  and  Endometritis ....  453 

Pyometra 458 

The  Infections  of  the  Gravid  Uterus 462 

Apical  Endometritis  with  Necrosis  of  the  Fetal  Sac 462 

Diffuse  Endometritis,  with  Atony  of  Uterine  Walls.     Dystocia  464 

Cervical  Endometritis 465 

Uterine  Gangrene 467 

Placentitis 469 

Peripheral  Placentitis  with  Necrosis  and  Dehiscence  at  the 

Periphery  of  the  Cotyledons 469 

Inter-Placental  Hemorrhage  with  Desiccation  of  the  Fetus. 

Mummification 470 

Incarcerating  Placentitis      474 

Necrosis  of  Cotyledons.     Necrotic  Placentitis        ...  474 

Adventitious  Placenta 475 

Calcification  of  Placenta 476 

The  Infections  of  the  Ovum,  Embryo  and  Fetus 476 

The  Death  of  the  Fertilized  Ovum 476 

The  Death  of  the  Embryo,  with  Survival  of  the  Embryonic  Sac. 

Cystic  Mole 477 

Death  and  Maceration  of  the  Embryo  or  Fetus '  480 

The  Pyometra  of  Fetal  Decomposition 480 

Abscessation  of  the  Gravid  Uterus .  4S4 

Emphysema  of  the  Fetus 487 

The  Observed  Expulsion  of  the  Fetal  Cadaver.     Abortion  .    .  487 

The  History  of  Abortion 4S8 

The  Prevalence  and  Frequency  of  Abortion 49  i 

"  Accidental  Abortion  " 495 

"Food  Abortion" 496 

The  Biology  of  Abortion 498 

The  Colon-Like  Bacillus  and  the  Micrococcus  of  Nocard  498 

The  Nodular  Venereal   Disease  of  Isepponi 499 

The  Bacterium  Abortus  of  Bang 499 

The  Paratyphoid  Bacillus  of  Moussu 511 

The  Spirillum  of  Smith  and  others 511 

Miscellaneous  Bacteria 511 


Cojiteiits 

The  Nature  of  Abortion 5" 

The  Symptoms  and  Diagnosis  of  Abortion 517 

The  Date  of  Invasion 51S 

The  Control  of  Abortion 519 

Diseases  of  the  Puerperal  Uterus 53^ 

Uterine  Hemorrhage.      Uterine  Hematoma 539 

Endometritis 546 

Septic    Metritis 554 

Placentitis,   Cotyledonitis.      Retained  Fetal  Membranes  .    560 

Puerperal  Tetanus 5^4 

Puerperal  Laminitis 5^5 

Puerperal    Meningitis 5^5 

Post-Puerperal  Uterine  Infections      5S6 

Endometritis 5^9 

Pyometra 594 

Uterine  Abscess 601 

Abscessation  of  Uterine  Submucosa 604 

Sclerotic  Metritis 605 

Pelvic  Adhesions.    Parametritis 606 

Pyemia,  Pyemic  Arthritis 609 

Pyemic  Abscesses 609 

Cystic  Degeneration  of  Uterine  Walls  with  Hydrometra  .    611 

Infections  of  the  Cervix 614 

Cervicitis 614 

Retention  of  Menstrual  Debris,  Cystic  Uterus 640 

Retention  of  Fetus  from  Cervical  Adhesions 641 

Retention  Cysts  of  Cervix 642 

Cervical  Prolapse 642 

Infections  of  the  Vagina 645 

Vaginitis.     The  Nodular  Venereal  Disease 645 

Gangrene 647 

Perivaginal  Phlegmon 648 

Cysts  and  Abscesses  of  Gartner's  Ducts 649 

The  Infections  of   the  Vulva 650 

HI.     CONGENITAL  INFECTIONS  OF  CALVES 
Dysentery  Neonatorum,  Cai.f  Scours,  White  Scours,  Cale 

Pneumonia,  Arthritis,  Pyemic  Abscesses 651 

The  Problem  of  the  Genital,  Infections  ok  Cattle  as  a 

Whole] ^^'^7 

The  Assembling  of  Herds  and  the  Addition  of   Cattle  to 

Existing  Herds    ,    .    .    .  ' 688 

Equipment 694 

The   vSystematic    Handling  of    Herds   for   the   Control   of 

Genital  Infections 697 

The  Genital  Infections  of  Cattle  as  an   Economic  Problem  708 


Co7itents  xvii 

The  Genitai,  Infections  of  Cattle  in  their  Relation  to 

Human  Health yoo 

SECTION  II.     THE  GENITAL  INFECTIONS  OF  SHEEP  AND  GOATS 
CHAPTER  XV 

THE  SPECIFIC  VENEREAL  DISEASES 713 

The  Nodular  Venereal  Disease 713 

CHAPTER  XVI 

NON-VENEREAL  INFECTIONS  WHICH  INVADE  THE  GENITAL 

ORGANS y,3 

Necrotic  Disease  of  the  Genital  Organs  Associated  with  Lip- 
and-Leg   Ulcerat 


ion 


713 

CHAPTER  XVII 

THE  GENERAL  GENITAL  INFECTIONS  OF  SHEEP  AND  GOATS  717 

Abortion  Associated  with  a  Vibrio  or  Spirillum 717 

Retained  Placenta  in  Ewes 717 

SECTION  HI.     GENITAL  INFECTIONS  OF  SWINE 
CHAPTER  XVIII 

SPECIFIC  VENEREAL  INFECTIONS 736 

The  Nodular  Venereal  Disease 736 

CHAPTER  XIX 
NON-VENEREAL  SPECIFIC  INFECTIONS  INVADING  THE 

GENITALIA  OF  SWINE 736 

Tuberculosis 736 

CHAPTER  XX 

THE  GENERAL  INFECTIONS  OF  THE  GENITALIA  OF  SWINE  .    738 

Metritis,  Death  and  Maceration  of  Embr3'os,  Abortion  ....    738 

SECTION  IV.     GENITAL  INFECTIONS  OF  HORSES  752 

CHAPTER  XXI 

THE  SPECIFIC  VENEREAL  DISEASES  OF  HORSES 752 


DOURINE 


752 


Genital  Horse  Pox 766 

CHAPTER  XXII 
NON-VENEREAL   SPECIFIC   DISEASES  WHICH   INVADE  THE 
GENITALIA  OR  AROUSE  INFECTIONS  ALREADY  EXISTING 

WITHIN  THE  GENITAL  TRACT 770 

Infectious  Cellulitis.     "Pink  Eye." 770 

bursattee 775 

CHAPTER  XXIII 
THE  GENERAL  INFECTIONS  OF  THE  GENITAL  TRACT.   "  CON- 
TAGIOUS ABORTION." 778 

INFECTIONS  OF  THE  GENITAL  ORGANS  OF  STALLIONS  ...    782 

Orchitis  and   Epididymitis 782 

Diseases  of  Seminal  Vesicles,  Semino- Vesiculitis 785 


xviii  Contents 

II.    GENERAL  INFECTIONS  OI<  THE  (xENITAE  ORGANS  OF  MARES 

Diseases  of  the  Ovaries.     Ovaritis i'i& 

Atretic  Follicles 788 

Cystic  Degeneration.     Nymplioniania 788 

Uterine  Infections 793 

Infections    of  the  Gravid  Uterus,     Ovum,    lunljryo    or    Fetus. 

Abortion 793 

Diseases  of  the  Puerperal  Uterus,  Retained  Afterbirth,  Reten- 
tion of  Non-Gravid  Horn  of  Chorion,  FIndoinetritis,  Puer- 
peral Uaminitis 799 

Metritis.    Metro-peritonitis .S03 

Post-Puerperal   Infections 805 

Endometritis S05 

Uterine  Abscess ' S06 

Pyometra 807 

Cervicitis 810 

Vaginitis .    .  Sii 

Vulvar  Gangrene g'S 

III.     CONGENITAL  INFECTIONS  OF  FOALS  814 

Septicemia  of  the  Foal .  814 

Retention  of  the  Meconium 814 

Dysentery 815 

Arthritis.     Pyemia 815 

Re-Opening  of  Urachus 820 

Rupture  of  Tendons 824 

SECTION  V.     THE  GENITAL  INFECTIONS  OF  CARNIVORA  S28 
CHAPTER  XXIV 
SPECIFIC  VENEREAL  DISEASES 

The  Venereal  Tumors  of  Dogs 82S 

CHAPTER  XXV 
THE   GENERAL   INFECTIONS  OF  THE    GENITALIA 

Prostatitis  of  Dogs.     Abortion,  etc 831 

CHAPTER  XXVI 

VENEREAL  DISICASE  OF  RABBITS 8;s 


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PART  I 

DISEASES  OF   THE   GENITAL  ORGANS   NOT 
ATTRIBUTED  TO  INFECTION 


Chapter  I 


THE  ANATOMY  AND  PHYSIOLOGY  OF 
THE  GENITAL  ORGANS 

A.     The  Male  Genitalia 

The  male  genital  organs  consist  of  the  testicles,  epididy- 
mes,  vasa  deferentia,  vesiculae  seminales,  prostate  and 
Cowper's  glands,  and  the  penis  with  its  sheath  and  prepuce. 

Prior  to  the  disappearance  of  the  Wolffian  bodies  in  the 
embryo,  there  appear  near  their  anterior  end  at  their  median 
side,  two  parallel  thickenings  in  the  peritoneum  designated 
the  genital  ridges,  which  by  an  elaboration  of  their  epithel- 
ium ultimately  form  the  genital  glands.  At  first  they  can- 
not be  differentiated,  but  they  quickly  assume  definite  sex 
characters  and  can  be  recognized  as  male  (testicles)  or  fe- 
male  (ovaries)  glands. 

1.    The  Testicles  and  their  Excretory  Ducts 

a.  The  testicles  at  first  lie  against  the  vertebral  column, 
in  close  proximity  to  each  other,  between  the  anterior  ends 
of  the  Wolffian  bodies.  The  essential  structures  of  the 
testicles,  the  tubuli  seminiferi  and  the  specialized  cells  ela- 
borating the  spermatozoa,  are  formed  from  the  peritoneal 
cells  of  the  genital  ridges.  The  contiguous  peritoneal  areas 
draw  over  the  genital  ridges,  perpetuating  the  general  peri- 
toneal surface  while  the  glandular  mass  of  the  testicle  lies 
outside  or  above  the  peritoneal  cavity. 

The  Wolffian  bodies  soon  disappear  as  independent  struc- 
tures. The  anterior  end  of  each  Wolffian  body  later  forms 
the  head  of  the  corresponding  epididymis,  becoming  continu- 
ous with  the  proximal  end  of  the  testicle,  upon  its  lateral 


2  Diseases  of  the  Genital  Organs 

side.  The  Wolffian  duct,  after  the  virtual  elimination  of  the 
Wolffian  body,  undergoes  elaboration  to  constitute  the  body 
and  tail  of  the  epididymis  and  the  vas  deferens. 

The  artery  of  the  testicle  derived  from  the  posterior  aorta, 
is  at  first  very  short,  but  with  the  descent  of  the  gland  into 
the  scrotum,  it  becomes  one  of  the  longest  unbranched  arter- 
ies in  the  body.  The  artery  with  its  satellite  vein,  nerves, 
and  lymphatics,  and  the  investing  peritoneum,  constitutes 
the  vascular  or  spermatic  cord,  one  of  the  three  fundamental 
connections  of  the  testicle  with  the  body  walls. 

A  second  attachment  of  the  testicle  to  the  body  wall  con- 
sists of  the  fibrous,  cord-like  gubernaculum  testis.  It  is 
formed  at  about  the  same  date  as  the  genital  ridge  and  ex- 
tends from  that  part  of  the  external  integument,  which  is  to 
constitute  the  fundus  of  the  scrotum  through  the  inguinal 
space,  internal  inguinal  ring,  and  thence  outside  the  peri- 
toneum, upward,  forward,  and  inward  across  the  tail  of  the 
epididymis  to  the  posterior  end  of  the  testicle  to  which  it  is 
attached. 

As  the  testicle  increases  in  volume  and  weight,  it  drops 
down  into  the  peritoneal  cavity  towards  the  internal  in- 
guinal ring.  In  its  descent  the  three  attachments  of  the 
testicle,  the  vascular  or  spermatic  cord  (artery,  vein,  nerves, 
and  lymphatics),  vas  deferens,  and  gubernaculum  testis, 
each  drags  with  it  the  peritoneum  which  furnishes  to  each 
structure  a  double  fold,  thus  maintaining  the  continuity  of 
the  visceral  with  the  parietal  peritoneum,  resulting  in  three 
double  peritoneal  folds,  as  shown  in  Fig.  1.  When  the  testi- 
cle descends  into  the  scrotum,  the  gubernaculum  shortens 
throughout  its  course.  In  solipeds  the  tension  of  the  guber- 
naculum, prior  to  the  complete  descent  of  the  testicle,  exerts 
a  degree  of  traction  upon  its  scrotal  attachment  sufficient  to 
cause  a  depression  or  dimple  in  the  scrotum.  The  approach 
of  the  testicle  to  the  internal  inguinal  ring  is  accompanied 
by  an  evagination  of  peritoneum  through  it  anterior  to  the 
gubernaculum,  to  constitute  the  processus  vaginalis,  which 
eventually  forms  the  parietal  peritoneum  of  the  scrotum. 
When  the  testicle  descends,  it  and  the  spermatic  cord  carry 


The  Male  Geyiitalia  3 

down  their  peritoneal  fold  which  extends  from  the  guber- 
naculum  below  the  origin  of  the  spermatic  artery  in  the 
lumbar  region.  It  is  attached  anteriorly  to  the  spermatic 
cord  and  posteriorly  to  the  scrotal  wall,  to  form  the  mesor- 
chium  which  constitutes  a  membranous  median  partition  in 
the  posterior  part  of  each  scrotal  sac  from  the  fundus  to  the 
internal  inguinal  ring,  as  shown  in  Figs.  2,  3,  and  4.  The 
processus  vagmalis,  in  everting,  pushes  before  it  on  the 
lateral  side  the  as  yet  invisible  cremaster  which  quickly  de- 
velops when  the  testicle  descends  into  a  bright  red,  highly 
functioning  muscle.  The  scrotal  sac  thus  consists  of  two 
distinct  groups  of  tissues,  the  general  integument  composed 
of  the  skin  and  dartos  and  the  intra-abdominal  portion  con- 
sisting of  the  parietal  peritoneum  and  the  cremaster  muscle 
with  the  intervening  fasciae.  The  two  groups  of  structures 
remain  easily  separable  throughout  life.  The  surgeon  in 
performing  the  "covered  operation,"  when  castrating  ani- 
mals with  scrotal  hernia,  avails  himself  of  this  distinction 


Fig.  I. — The  Testicle  and  its  Attachments. 
Right  inguinal  region  and  testicle  of  24  hrs.  colt.  P,  Processus  vaginalis  sur- 
rounded by  a  dotted  line  and  containing  a  curved  sound,  5" ;  G,  first  portion  of 
gubernaclum  testis  ;  G' ,  second  porlion  of  gubernaculum  testis  extending  to  the 
epididymis, j^"  ;  E,  epididymis  ;  G",  gubernaculum  extending  from  epididymis  (globus 
minor )  to  the  testicle  ;  7^,  testicle  ;  yi,  testicular  artery 
urinary  bladder  ;    UA,  umbilical  arteries. 


V,   V,  vasa  deferentia  ;  B, 


4  Diseases  of  the  Genital  Organs 

and  readily  separates  the  two  groups  between  the  dartos 
and  cremaster  so  that  he  may  Hgate  the  structures  of  intra- 
abdominal origin  just  at,  or  near  to,  the  internal  inguinal 
ring. 

In  domestic  animals,  except  the  elephant,  the  descent  of 
the  testicles  into  the  scrotum  is  a  prerequisite  to  fertility; 
otherwise,  spermatozoa  are  not  formed. 

In  the  descent  of  the  testicle,  the  gubernaculum  shortens, 
the  processus  vaginalis  develops,  and  the  tail  of  the  epididy- 
mis with  the  caudal  end  of  the  testicle  traverses  the  inguinal 
ring  followed  by  the  body  and  head  of  the  epididymis  and 
cephalic  end  of  the  testicle. 

The  descent  of  the  epididymis  and  testicle  of  ruminants 
is  directly  downward.  The  gland  comes  to  rest  with  the  tail 
of  the  epididymis  and  that  portion  of  the  testicle  which  was, 
in  the  embryo,  the  posterior  end  directed  downward.  The 
long  axis  of  the  testicle  is  perpendicular  to  the  spinal  column. 
The  epididymis  thus  rests  upon  the  postero-lateral  face  of 
the  testicle,  its  head  directed  toward  the  internal  inguinal 
ring,  its  tail  at  the  distal  end  of  the  testicle.  The  vas  de- 
ferens passes  inward  across  the  lower  margin  of  the  mesor- 
chium  and  turns  upward  on  the  postero-median  surface  of 
the  testicle  closely  applied  to  it.  The  epididymis  and  vas 
deferens  are  thus  parallel  and  separated  from  each  other  by 
the  mesorchium  or  peritoneal  fold  connecting  the  visceral 
and  parietal  layers.  It  is  important  to  remember  this  ar- 
rangement of  structures  when  examining  clinically  the  testi- 
cles for  evidences  of  disease. 

In  solipeds  the  cutaneous  attachment  of  the  gubernaculum 
testis  is  farther  posterior  and  higher  than  in  ruminants. 
This  draws  the  tail  of  the  epididymis  upward  and  backward 
causing  its  head  and  the  corresponding  end  of  the  testicle  to 
tilt  forward.  The  gland  revolves  through  90  degrees  on  its 
short  axis  and  comes  to  rest  with  its  long  axis  parallel  to  the 
spinal  column.  The  vas  deferens,  instead  of  doubling  back 
along  the  postero-median  surface  of  the  testis  as  in  the  rumi- 
nant, leaves  the  horizontal  testicle  immediately  at  the  tail 
of  the  epididymis  and  passes  obliquely  upward  and  forward, 
to  come  in  contact  with  the  vascular  cord  in  the  inguinal 
canal. 


The  Male    Genitalia 


Fig.  2— Testicles  of  Bull. 
Section  through  the  posterior  scrotal  wall  of  the   bull.     The   left   testicle   is 
fully  exposed,  the  right  is  covered  by  the  creuiaster  muscle  and  tascia  and   by 
the  scrotal  peritoneum.     C  Cremaster  muscle  divided  longitudinally  ;  .S,  sper- 
matic cord  ;  E,  head  of  epididvniis  ;  E' ,  body  ditto  ;  E" ,  tail  ditto. 


6  Diseases  of  the  Genital  Organs 

The  gubernaculum  of  carnivora  has  its  cutaneous  at- 
tachment higher  and  more  posteriorly  than  that  of  soHpeds, 
the  testicles  are  drawn  further  backward  and  upward  so  that 
they  rest  between  the  posterior  portions  of  the  thighs,  and 
the  glands  are  tilted  so  that  their  long  axes  are  obliquely 
downward  and  forward  from  the  tail  of  the  epididymis. 
Finally,  in  swine,  the  cutaneous  origin  of  the  gubernaculum 
testis  is  located  high  in  the  perineal  region  just  beneath  the 
anus,  and  the  tail  of  the  epididymis  with  the  lesser  extrem- 
ity of  the  testicle  is  caught  and  held  at  that  point  with  the 
head  of  the  epididymis  and  greater  end  of  the  testicle  pre- 
senting almost  perpendicularly  downward.  Its  direction  in 
the  scrotum  is  almost  the  reverse  of  the  testicle  of  the 
ruminant. 

b.  The  epididymis,  Figs.  2,  3,  4,  is  formed  in  part  from 
the  tubules  of  the  Wolffian  body  and  partly  from  the  Wol- 
ffian duct.  That  portion  of  the  epididymis  derived  from  the 
tubules  of  the  Wolffian  body  leaves  the  anterior  or  cephalic 
end  of  the  embryonic  testicle  as  a  series  of  greatly  coiled 
tubules  which  constitute  an  enlarged  mass  designated  the 
head,  or  globus  major,  of  the  epididymis.  The  tubules  all 
converge  to  become  the  single  tubule  representing  the  Wol- 
ffian duct.  The  latter,  greatly  coiled,  forms  the  enlongated 
body  of  the  epididymis  which  is  equal  in  length  to  about 
three-fourths  of  the  long  diameter  of  the  testicle.  At  the 
caudal  or  tail  end  of  the  testicle  the  single  tube  becomes 
greatly  coiled  to  constitute  a  second  enlargment,  the  tail, 
or  globus  minor.  The  tube  then  becomes  less  coiled  and 
finally  straight  to  constitute  the  vas  deferens. 

The  head  of  the  epididymis,  through  the  tubules,  the  vasa 
deferentia,  is  continuous  with  the  tubular  structure  of  the 
testicle,  and  through  these  the  spermatozoa  escape  from  the 
gland  and  reach  the  single  tube  of  the  body  and  tail  of  the 
epididymis  which  in  turn  is  continued  by  the  vas  deferens. 
Only  the  head  of  the  epididymis,  therefore,  is  continuous 
with  the  tissues  of  the  testicle,  while  the  body  and  tail  lie 
closely  moulded  against  the  gland  and  attached  to  it  through 
the  agency  of  peritoneum  and  connective  tissue.  The  tail  and 


The  Male  Genitalia  7 

body  of  the  epididymis  are,  therefore,  only  loosely  attached 
to  the  testicle  and  these  permit,  under  some  circumstances, 
of  wide  separation  from  the  gland.  Thus  in  cryptorchidy  in 
the  horse,  the  gubernaculum,  as  shown  in  Fig.  1,  crosses  the 
tail  of  the  epididymis  and  is  closely  attached  to  it.  In  enter- 
ing the  inguinal  ring,  the  tail  of  the  epididymis,  with  the 
gubernaculum,  must  lead  and  physiologically  the  tail  of  the 
testicle  must  accompany  it.  But  sometimes  the  caudal  end 
of  the  testicle  becomes  caught  at  the  ring,  the  tail  of  the 


P^iG.  3 — Cross  Section  through  Scrotum  and  Testicles  of  Bull  Calf. 
/,    /,  Body   of   epididymis  ;    2,    2,  vas   deferens    on   the   anterior   side   of   the 
mesorchium. 

epididymis,  followed  by  the  body,  and  even  the  head,  passes 
through  the  ring,  the  testicle  turns  upon  its  transverse  axis, 
and  its  head  becomes  incarcerated  in  the  inguinal  ring,  its 
caudal  end  remaining  within  the  abdomen.  The  inexperi- 
enced surgeon  attempts  to  castrate  the  cryptorchid,  en- 
counters the  epididymis  in  the  peritoneal  pouch  and  am- 
putates it  from  the  testicle  under  the  impression  that  he  is 
castrating  the  animal.  Later  a  second  operation  is  neces- 
sary and  within  the  abdomen  there  is  found  a  "third  testicle." 


'8  Diseases  of  the  Genital  Orgaiis 

A  study  of  Fig.  1  will  show  that  in  the  descent  of  the 
testicle  and  attached  structures,  a  broad  peritoneal  sheet, 
the  mesorchium,  is  formed,  extending  from  the  spermatic 
artery,  A,  to  the  gubernaculum,  G.  Midway  in  this  a  sec- 
ond peritoneal  duplicature  leaves  the  broad  expanse  to  en- 
velop the  vas  deferens,  V.  The  ruminant  testicle  descends 
directly  and  in  doing  so,  the  first  section  of  the  gubernacu- 
lum, G,  passes  through  the  inguinal  ring  followed  by  the  tail 


Fig.  4  -Cross  Section  through  Scrotum  of  Young  Bull  viewed  from 
Posterior  Side. 
/,  /,  Body  of  epididymis  ;  2,  2,  vas  deferens.     The  ri<^ht  U  sticle  has  revolved  on 
its  long  axis  so  that  the  epididymis  and  vas  diferens  witli  the  mesorchium  between 
them  rest  ui)on  the  postero-extenial  surface  of  the  j^laiid. 

of  the  epididymis,  E,  with  the  caudal  end  of  the  testicle,  and 
when  this  point  reaches  the  fundus  of  the  scrotum  and  the 
basal  point  of  the  attachment  of  G  to  the  dartos,  the  descent 
is  completed.  The  testicle  of  the  bull  descends  in  a  direct 
line  and  when  it  comes  to  rest  upon  the  bottom  of  the  scro- 
tum by  its  caudal  end,  it  remains  upright,  with  the  epi- 
didymis lying  against  its  median  side  on  the  outer  side  of 
the  mesorchium,  and  the  vas  deferens  upon  its  median  side. 
The  spermatic  artery.  A,  instead  of  leaving  the  gland  per- 


The  Male  Genitalia  g 

pendicular  to  the  long  axis,  shifts  its  course  and  leaves  the 
head  end  of  the  testicle  in  a  direct  line  parallel  to  the  long 
axis  of  the  gland.  This  causes  the  vas  deferens  to  turn  ab- 
ruptly at  E  and  follow  the  mesorchium  on  its  median  sur- 
face along  the  testicle  until  at  the  cephalic  end  of  the  latter, 
it  joins  the  artery  to  contribute  to  the  spermatic  cord.  In 
the  bull  the  gubernaculum  is  anchored  in  the  median  wall  of 
the  scrotum  with  the  result  that  both  the  epididymis  and  vas 
deferens  are  normally  applied  against  the  postero-median 
side  of  the  testicle,  as  shown  in  Figs.  2-4,  the  epididymis 
behind,  and  the  vas  deferens  in  front  of  the  mesorchium. 
The  head  of  the  epididymis  of  the  bull  begins  superiorly 
upon  the  lateral  surface  of  the  cephalic  end  of  the  testicle, 
passes  across  the  posterior  surface  upward,  medianward, 
and  then  downward,  in  the  form  of  an  arc.  It  is  flattened 
against  the  surface  of  the  testicle  and  is  not  materially  en- 
larged to  form  a  "globus  major"  as  in  the  horse.  The  tail 
of  the  epididymis,  or  globus  minor,  on  the  other  hand,  is 
large  and  prominent.  It  projects  definitely  beyond  the  cau- 
dal end  of  the  testicle  and  lies  chiefly  on  the  postero-median 
surface  where  it  is  readily  palpable  and  visible  through  the 
scrotum.  It  is  the  dominant  seat  of  infection  in  the  epi- 
didymis, with  or  without  abscessation,  and  as  such  merits 
special  attention. 

The  descent  of  the  testicle  of  the  horse  is  at  first  funda- 
mentally the  same  as  that  of  the  bull  but  upon  reaching  the 
scrotum,  the  head  end  tilts  forward  and  finally  comes  to  rest 
with  its  long  axis  parallel  to  the  spinal  axis.  The  epi- 
didymis consequently  lies  upon  the  dorsal  surface  of  the 
testicle,  lateral  to  the  mesorchium,  and  the  vas  deferens,  in- 
stead of  turning  forward  along  the  median  side  of  the 
mesorchium,  is  free  from  the  gland  and  upon  leaving  the 
tail  of  the  epididymis,  passes  directly  upward  and  forward 
to  join  the  artery  near  the  external  abdominal  ring.  This 
results  in  a  very  marked  difference  in  relation  and  subjects 
the  testicle  of  the  horse  to  the  possibility  of  torsion. 

After  the  vas  deferens  has  joined  the  spermatic  artery,  its 
behavior  is  essentially  alike  in  all  species.     It  accompanies 


lo  Diseases  of  the  Genital  Organs 

the  artery  through  the  inguinal  ring,  parts  there  from  it 
and,  curving  upward,  inward,  and  backward,  finally  ap- 
proaches its  fellow  from  the  opposite  side,  passes  above  the 
neck  of  the  urinary  bladder  between  or  beneath  the  seminal 
vesicles,  and  enters  the  urethra  from  above.  It  is  reaily 
palable  per  rectum  in  the  horse  and  bull. 

2.    The  Vesiculae  Seminales,  Prostate,  and 
Cowper's  Glands 

The  subsidiary  sex  glands  and  appendages  to  the  sex 
organs  of  domestic  animals  show  wide  variations.  Each 
vesicula  seminalis  is  formed  as  an  outgrowth  from  the  vas 
deferens.  In  most  animals  the  vesicle  consists  of  a  long, 
intricately  folded,  coecal  tubule  which,  when  incised,  ap- 
pears like  an  acinous  gland.  In  solipeds  the  structure  as- 
sumes the  form  of  a  vesicle  similar  in  outline  to  the  urinary 
bladder.  The  two  vesicles  in  the  horse  are  oblong,  about 
six  to  eight  inches  long  by  two  inches  in  diameter,  their 
anterior  ends  round.  The  posterior  ends  taper  sharply  to 
their  outlet.  They  lie  side  by  side  above  the  neck  of  the 
urinary  bladder  and  the  termination  of  the  vas  deferens. 
Their  walls  are  thick  and  their  mucosa  richly  supplied  with 
glands.  The  vesiculae  secrete  a  thin  mucoid  fluid,  presumed 
to  dilute  the  semen  at  the  time  of  ejaculation.  Ordinarily 
the  vesicle  contains  a  small  amount  of  this  secretion,  and 
occasionally  a  few  spermatozoa  make  their  way  into  the 
cavity,  but  the  organ  does  not  serve  as  a  seminal  reservoir 
in  any  domestic  animal.  In  the  gelding  the  vesiculae  some- 
times suffer  from  catarrhal  accumulation.  When  attempt- 
ing to  catheterize  geldings,  the  catheter  sometimes  passes 
into  the  dilated  orifice  of  the  vesicle  and  lodges,  rendering 
it  difficult,  and  sometimes  impossible,  for  the  operator  to 
pass  the  catheter  into  the  urinary  bladder. 

In  ruminants  the  vesiculae  seminales  are  composed  of 
greatly  elongated  tubules  so  coiled  as  to  give  to  the  structure 
the  appearance  of  an  acinous  gland.  In  the  bull  (See 
Figs.  5,  6,  7)  the  seminal  vesicles  are  two  oblong,  nodular 
bodies  varying  with  the  size  of  the  animal  from  two  to  three 


The    Vesiculae  Seviinaks 


Fio.  5  Fig.  6 

Glands  Attached  to  Pelvic  Urethra  of  Bull  viewed  from  above. 

Fig.  5.  A,  Accelerator  urinae  muscle  sectioned  horizontally  ;  C  C  Cowper's 
glands  ;  W,  Wilson's  muscle  ;  P,  body  of  prostrate  ;  .S",  5,  seminal  vesicles  ;  D,  D, 
vasa  deferentia  ;   U,  ureter  ;  B,  urinary  bladder  ;  /,  ischio-cavernosus  muscle. 

Fig.  6.  A  transverse  section  has  been  made  through  the  posterior  part  of  Wil- 
son's muscle  and  the  urethra  and  a  median  section  through  the  accelerator  urinae 
muscle  and  Gowper's  gland.  A,  Accelerator  urinae  muscle  ;  C,  Cowper's  gland 
just  above  the  urethra.     Other  lettering  same  as  in  Fig.  5. 


12  Diseases  of  the  Geriital  Organs 

inches  in  length,  one  to  one  and  a  quarter  inches  in  width, 
and  approximately  one  half  inch  in  diameter  from  above 
to  below.  They  are  readily  palpated  per  rectum,  by  which 
means  they  are  recognized  as  oblong  bodies  meeting  poster- 
iorly on  the  median  line  where  their  ducts  empty  into  the 
urethra,  while  anteriorly  they  diverge  and  drop  down  upon 
a  level  with  the  urethra.  They  can  be  partially  picked  up 
and  give  to  the  examiner  a  sensation  of  a  nodular,  acinous 
gland.  In  swine  the  seminal  vesicles  are  very  large  and 
similar  in  character  to  those  of  the  bull.  The  structures 
are  absent  in  the  dog. 

Physiologically  they  appear  to  be  of  fundamental  im- 
portance in  those  animals  where  present  since  they  ap- 
parently furnish  a  thin,  mucoid  secretion  which  contributes 
the  greater  volume  of  the  seminal  fluid.  In  those  animals 
where  it  is  not  present,  its  place  appears  to  be  taken  by  an 
increased  volume  and  activity  of  the  prostate  gland. 

The  prostate  glands,  lying  across  the  urethra  just  behind 
the  posterior  ends  of  the  seminal  vesicles,  are  small  in  the 
horse. 

The  prostate  of  the  bull  is  of  about  the  same  volume  as 
either  of  the  seminal  vesicles.  The  body  of  the  prostate  is 
a  small,  yellowish,  transverse  band  lying  across  the  urethra 
just  behind  the  termination  of  the  seminal  vesicles  and  in 
front  of  the  anterior  end  of  Wilson's  muscle,  as  shown  in 
Fig.  6.  Posteriorly,  it  extends  to  the  vicinity  of  Cowper's 
glands.  It  surrounds,  but  lies  chiefly  above,  the  urethra. 
On  cross  section  it  shows  a  U-shaped  structure  with  the 
urethral  canal  lying  in  the  bottom  of  the  U.  Below  and 
at  the  sides,  it  is  heavily  covered  by  Wilson's  muscle,  and 
above,  the  aponeurosis  of  the  muscle  stretches  across  from 
side  to  side  so  that  this,  the  more  voluminous  and  important 
portion  of  the  gland,  is  completely  hidden  from  sight  and 
touch.  Only  the  body,  or  that  portion  not  covered  by 
Wilson's  muscle,  is  palpable  per  rectum. 

The  gland  is  of  moderate  size  in  the  boar.  In  carnivora 
the  prostate  glands  are  large  and  apparently  perform  the 
functions  of  the  absent  vesiculae  seminales.     It  is  virtually 


The    Vesiculae  Scminale 


13 


Fig.  7.  Same  as  Figs.  5  and  6  with  same  lettering.  The  left  hand  figure  is  from 
a  bull  calf.  In  the  right  figure  a  median  section  through  the  posterior  part  of  the 
urethra  has  been  made  exposing  to  clear  view  Cowper's  gland,  C. 


14 


Diseases  of  the  Genital  Organs 


only  in  the  dog,  amongst  domestic  animals,  that  the  prostate 
gland  assumes  pathologic  importance. 

Cowper's  glands  are  present  in  solipeds,  ruminants,  and 
the  cat.  They  lie  on  either  side  of  the  urethra  in  the 
perineal  region  above  the  ischial  arch.  They  have  little  or 
no  known  pathologic  importance.  The  glands  are  absent  in 
the  dog. 

3.    The  Penis 

The  penis  of  domestic  animals  is  normally  completely 
hidden,  when  at  rest,  within  the  sheath,  and  the  glans  penis 
has  a  second  covering,  the  prepuce.  The  soliped  and  dog 
ordinarily  protrude  the  penis  out  of  both  prepuce  and 
sheath  during  urination.     The  protrusion  of  the  penis  dur- 


FiG.  S— Penis  of  Calf  with  Preputial  Sac  Unopened. 
S,  Sheath;   U,  urethra  ;  P,  prepuce,  not  yet  free  from  the  glans  ;   C/,  glaus.    Be- 
tween the  prepuce  and  the  ghins  is  soft  embr^-onic  tissue.   l-\  fornix  ;  C,  C,  corpus 
cavernosum. 

ing  coitus  or  sexual  excitement  is  brought  about  by  its 
erection  and  by  the  relaxation  of  the  retractor  penis  muscle. 
In  solipeds  and  carnivora,  the  retractor  muscle  is  closely 
applied  throughout  its  length  to  the  ventral  side  of  the 
penis,  so  that  the  length  of  the  retractor  muscle  from 
the  tuber  ischii  to  its  penial  insertion  is  identical  with 
the  length  of  the  penis  from  the  ischial  notch  to  the 
muscular  insertion.  In  ruminants  and  swine,  the  muscle 
is  not  closely  applied  to  the  ventrum  of  the  penis  but 
passes  directly  across  the  postero-inferior  mouth  of  the 
curvature  of  that  organ  without  following  its  course  so 
that  the  length  of  the  muscle  is  only  about  one-half  that  of 
the  penis  from  the  ischial  notch  to  the  muscular  insertion. 


The  Penis 


15 


Thus  it  occurs  that  the  protrusion  and  retraction  of  the 
penis  are  brought  about  in  a  different  manner  in  the  horse 
from  that  observed  in  ruminants  and  swine.  The  penis  of 
the  soliped  is  protruded  chiefly  through  an  elongation  of 
the  organ  itself  in  the  process  of  erection ;  the  penis  of  the 
ruminant  is  protruded  largely  through  the  elimination  of  the 
S-curve  and  temporary  lengthening  of  the  retractor  penis 
muscle. 


Fig.  9— Penis  of  Calf  with  Sheath  forcibly  Everted  showing 
Unopened  Preputial  Sac.  x  3. 

Ps,  Preputial  sac.     Other  lettering  same  as  in  Fig.  8. 

4.    The  Sheath  and  Prepuce 

Veterinary  anatomists  commonly  use  the  words  "sheath" 
and  "prepuce"  as  synonomous  terms.  When  studying  the 
diseases  of  the  genital  organs,  it  is  preferable  to  different- 
iate the  sheath  and  prepuce  as  two  separate  structures  of 
different  embryologic  history.  It  will  simplify  the  study  of 
the  pathology  of  these  structures  if  the  prepuce  is  regarded 
as  that  sac  which  reaches  from  the  fornix,  or  base  of  the 
glans,  to  its  apex  when  the  organ  is  at  rest.  The  sheath 
begins  at  the  apex  of  the  penis,  when  the  organ  is  at  rest, 
and  extends  forward  to  the  exterior  opening  where  it  be- 
comes continuous  with  the  general  integument.     The  pre- 


i6  Diseases  of  ihr  Genital  Organs 

puce  is  wholly  free  from  hairs;  the  sheath  at  its  external 
opening  contains  numerous  hairs.  In  the  bull  these  are 
greatly  developed  to  constitute  the  preputial  tuft.  The  pre- 
putial sac  of  solipeds  forms  and  opens  early  in  embryonic 
life,  but  ruminants  and  swine  are  born  without  this  struc- 
ture. The  new-born  male  soliped  can  readily  protrude  the 
penis  and  commonly  does  so  when  urinating.  The  young 
ruminant  and  porcine  male  cannot  protrude  the  penis,  as 
is  shown  in  Figs.  8  and  9,  and  necessarily  urinate  in  the 
sheath.  With  the  advent  of  puberty,  the  frail  layer  of  em- 
bryonic tissue,  serving  to  bind  the  prepuce  to  the  glans, 


Fig.  9a  — Penises  of  Steers  showing-  various  degrees  in  the 
development  of  the  Prepuce. 

The  left  hand  li}.(urc-  sliows  in  Ihc  gluii.s  a  few  ulevalion.s  from  the  j;ranular 

venereal  disease. 


The  Sheath  a7id  Preptice  17 

slowly  yields  and  the  preputial  sac  opens,  after  which  the 
penis  may  be  protruded.  If  the  young  animal  is  castrated 
early,  the  formation  of  the  prepuce  is  held  in  abeyance  at 
varying  stages.  The  animal  must  then  urinate  within  the 
sheath  throughout  life  and  is  subject  to  special  diseases  not 
observed  in  entire  males.  In  the  young  lamb,  the  urethral 
orifice  at  the  tip  of  the  vermiform  appendix  of  the  penis 
opens  into  the  fundus  of  the  sheath,  the  tip  of  the  vermiform 
appendix  accordingly  indicating  the  line  of  demarcation  be- 
tween the  sheath  and  the  eventual  preputial  sac. 


Fig.  10— Sheath,  Prepuce  and  Retracted  Penis  of  Bull. 

F  Fornix  ;   G,  glaus  ;   P,  prepuce  ;  5",  sheath. 

The  epithelial  coverings  of  the  glans  penis  and  the  pre- 
puce of  solipeds  are  corneous  and  highly  protective.  They 
produce  a  moist  sebum  in  the  sinus  about  the  urethral  open- 
ing, but  over  the  rest  of  its  surface  the  sebum  is  normally 
dry  and  forms  gross  masses  of  crusts  which  are  readily 
detached.  In  ruminants,  swine,  and  carnivora,  on  the  con- 
trary, the  preputial  sac  and  glans  penis  are  covered  by  a 
very  delicate  mucous  membrane  which  normally  secretes 
sufficient  mucus  to  keep  the  parts  constantly  moist.  The 
prepuce  of  ruminants  and  of  swine  is  accordingly  more 
vulnerable  to  abrasions  and  infections  than  that  of  solipeds, 
and  affects  quite  profoundly  the  type  of  lesions  observed  in 
the  two  classes.  The  preputial  secretions  are  not  as  a  rule 
markedly  odoriferous. 

The  sheath  of  all  domestic  animals  secretes  a  smegma 
having  a  specific  odor.  The  boar  has  two  culs-de-sac  in  the 
superior  wall  of  the  sheath  which  may  contain  as  much  as  a 


i8  Diseases  of  the  Geyiital  Organs 

pint  of  highly  fetid  urine  and  smegma.  In  the  barrow 
these  cavities  are  much  smaller  but  contain  a  similar  fetid 
material. 

When  the  penis  is  protruded  as  in  copulation,  the  glans 
penis  pushes  its  way  out  of  the  prepuce  and  that  membrane 
becomes  everted  to  constitute  the  covering  of  the  penis  from 
the  fornix  backward  for  a  distance  approximately  equal  to 


Fig.  II — Sheath,  Prepuce  and  Protruded  Penis  of  Bull. 
Lettering  same  as  in  Fig.  lo. 

the  length  of  the  glans.  The  further  protrusion  of  the  penis 
requires  the  eversion  of  the  sheath  by  which  it  becomes  the 
visceral  covering  of  the  base  of  the  penis.  It  thus  transpires 
that  the  prepuce  and  sheath,  the  epithelial  surfaces  of  which 
face  inwardly  while  the  penis  is  at  rest  with  a  cavity  be- 
tween them  and  the  penis,  become  reversed  when  the  organ 
is  erected  and  constitute  its  immediate  covering  with  its  epi- 
thelium facing  outward.  The  general  plan  is  indicated  in 
Figs.  8-11. 

B.     The  Female  Generative  Organs 

The  genital  system  of  the  mammalian  female  consists  of 
the  ovaries,  oviducts,  uterus,  cervix,  vagina,  and  vulva. 

1.    The  Ovaries 

The  ovaries  are  the  essential  reproductive  glands  of  the 
female.     They  perform  the  fundamental  generative  func- 


The  Ovaries  19 

tion  by  elaborating  the  ovum,  or  Q%%y  which,  after  being 
discharged  from  the  ovary  and  fertilized  by  the  spermato- 
zoon, becomes  a  distinct,  but  in  mammalia  not  immediately 
an  independent,  being.  The  fertilized  ovum  is  still  depend- 
ent for  a  time  upon  the  oviducts  for  its  transportation  to  the 
uterus,  upon  the  uterus  for  its  nutrition  and  protection  dur- 
ing pregnancy  and  its  expulsion  at  fetal  maturity,  and  upon 
the  milk  from  the  udder  of  the  mother  as  food  immediately 
after  birth. 

The  size,  form,  and  location  of  the  ovaries  of  domestic 
animals  differ  greatly  according  to  species,  breed,  age,  and 
individual ;  even  the  two  glands  in  the  same  animal  are  not 
ordinarily  alike  and  may  vary  greatly  in  size  and  form.  The 
ovary  of  the  mare  is  much  the  largest  seen  in  the  domestic 
animals,  reniform,  very  dense  owing  to  its  thick  tunica  al- 
buginea,  with  a  smooth  surface  which  is  elevated  here  and 
there  in  many  cases  by  the  presence  near  the  surface  of 
cysts  varying  from  less  than  0.25  inch  to  2  or  more  inches 
in  diameter.  The  gland  attains  its  maximum  size  when  the 
animal  has  reached  the  age  of  three  or  four  years,  and  be- 
gins to  atrophy  at  ten  to  fifteen  years,  to  become  very  small 
and  fibrous  as  age  advances.  The  ovary  of  the  young  mare 
is  usually  3I/2  to  4  inches  in  its  greatest  diameter  and  weighs 
about  4  ounces,  while  in  the  aged  it  may  shrink  to  II/2  inch 
in  its  greatest  diameter  and  in  weight  to  14  ounce.  The 
ovary  of  the  cow  is  much  smaller  than  that  of  the  mare, 
varying  in  its  greatest  diameter  between  0.25  and  2  inches 
and  weighing  about  0.25  to  0.5  ounce ;  it  is  oblong  and  gen- 
erally regular  in  outline ;  its  tunica  albuginea  is  only  moder- 
ately dense.  The  ovary  of  the  sow  is  comparatively  very 
large.  The  numerous  ovisacs  appear  prominently  on  its  sur- 
face in  such  a  manner  that  the  most  superficial  of  them 
stand  out  entirely  beyond  the  general  ovarian  surface  at- 
tached to  the  body  of  the  organ  by  a  somewhat  constricted 
neck.  The  ovary  of  the  cat  is  very  oblong,  with  pointed  ex- 
tremities, and  of  a  bright  scarlet  color,  with  the  ovisacs 
standing  out  thickly  over  the  surface  in  a  way  suggesting 
a  mulberry. 


20  Diseases  of  the  Genital  Organs 

The  ovary  of  the  bitch  is  very  small,  livid  in  color,  even 
in  outline,  and,  unlike  those  of  other  domestic  animals,  is 
completely  enveloped  in  the  pavilion  of  the  oviduct,  except 
for  a  minute  oblong  opening  of  so  small  size  that  the  gland 
can  not  be  readily  exposed  to  plain  view  through  it. 

The  location  of  the  ovary  in  the  adult  varies  much  with 
species.  The  size  of  the  gland,  when  normal,  has  little  or 
no  influence  upon  its  position.  It  rests  upon  the  superior 
surface  of  the  anterior  border  of  the  broad  ligament  of  the 
uterus,  naked  in  most  animals  but  closely  invested  in  the 
bitch  by  the  pavilion  of  the  oviduct.  The  pavilion  of  the 
oviduct  in  the  mare  is  attached  by  one  of  its  fimbria  to  the 
ovary  near  its  hilus,  and  its  connection  with  the  uterus  is 
further  maintained  by  the  utero-ovarian  ligament,  com- 
posed largely  of  connective  tissue  and  pale  muscle  fibers. 
In  the  cow  one  of  the  fimbriae  of  the  pavilion  is  adherent 
to  the  outer  or  lateral  end  of  the  ovary.  The  ovary  is  also 
influenced  in  its  position  by  the  round  ligament,  which  is 
analogous  to  the  gubernaculum  testis  of  the  male.  Arising 
like  the  latter  from  the  skin  and  dartos  at  the  point  where 
the  fundus  of  the  scrotum  of  the  male  normally  appears  in 
the  given  species,  it  extends  up  through  the  inguinal  ring 
behind  the  peritoneum,  to  become  attached  to  the  uterine 
cornu  or  oviduct,  not  far  from  the  ovary.  Its  attachments 
tend  to  cause  the  ovary  to  follow  a  line  of  descent  compar- 
able to  that  of  the  testicle,  but  normally  it  becomes  arrested 
in  its  migration  at  some  point  between  its  place  of  origin 
and  the  internal  inguinal  ring.  In  the  bitch,  it  remains 
closely  applied  to  the  sub-lumbar  region,  immediately  be- 
hind the  kidney,  virtually  at  its  point  of  origin.  In  the 
mare,  its  movement  is  arrested  early  and  it  remains  rather 
firmly  suspended  not  far  behind  the  kidney  and  above  the 
middle  of  the  posterior  part  of  the  abdominal  cavity.  The 
ovary  of  the  ruminant  lies  loosely  in  the  pelvis,  alongside 
the  cervix  uteri  or  the  base  of  the  cornu,  behind  the  in- 
ternal inguinal  ring,  or  just  in  front  of  the  pubic  brim, 
somewhat  below  it,  resting  upon  the  abdominal  floor..  The 
ovary  of  the  sow  floats  quite  freely  in  the  peritoneal  cavity 


The  Ovaries  21 

and  abnormally  at  times  passes  out  through  the  inguinal 
ring  and  comes  to  rest  in  that  part  of  the  perineal  region 
corresponding  to  the  scrotum  of  the  boar.  The  same  dis- 
placement of  the  ovary  occurs  rarely  in  bitches.  It  is 
possible  in  any  species.  In  general  it  may  be  said  that  in 
the  elongated  uteri  of  muciparous  animals  the  ovaries  are 
situated  further  forward  than  in  the  uniparous  or  biparous 
genera.  The  location  of  the  ovary  is  further  modified  by 
the  pregnant  state.  The  gravid  uterus,  in  its  descent, 
drags  the  gland  downward  and  forward.  It  is  also  drag- 
ged downward  and  forward  by  any  increase  in  weight  due 
to  disease  of  the  uterus,  oviducts,  or  ovary,  such  as  pyome- 
tra,  tumors  of  the  uterus,  oviducts  and  ovaries. 

The  functional  activity  of  the  ovary  modifies  its  size  and 
form.  During  the  breeding  life  of  the  animal  the  cortex, 
or  peripheral  area,  of  the  ovary  is  largely  composed  of  ^^% 
columns,  or  masses,  consisting  of  germinal  cells  arranged 
in  the  form  of  a  hollow  sphere.  Resting  upon  an  intruding 
mass  of  genital  cells  is  a  specially  developed  cell,  the  ovum. 
The  spheroidal  hollow  mass  of  cells  contains  a  fluid,  the 
follicular  liquid.  When  an  ovum,  or  ova,  matures  and  an 
ovisac  ripens,  the  female  is  in  estrum  or  "heat."  The 
ovisac  becomes  distended  with  follicular  fluid,  presses  aside 
the  superposed  ovarian  tissues,  and  attenuates  or  destroys 
the  tunica  albuginea  at  the  involved  point.  In  most  ani- 
mals the  active  ovisac  pushes  its  way  above  the  general 
ovarian  surface  as  a  hemispherical  cyst  with  very  thin 
walls.  In  the  mare  it  regularly  protrudes  at  the  hilus  of 
the  gland,  where  it  is  not  readily  apparent.  The  ripe  ovisac 
— or  ovisacs — ruptures  at  the  close  of  estrum,  producing  a 
lesion,  which  usually  behaves  differently  according  to 
whether  the  discharged  ovum  becomes  fertilized  and  un- 
dergoes development  into  a  fetus  or,  failing  of  fecundation, 
perishes.  The  crater  resulting  from  the  rupture  of  the  sac 
becomes  filled  with  lymph,  blood,  or  other  products  of  the 
disturbances  of  the  tissues.  Should  the  ovum  perish,  the 
lesion  tends  to  heal  rapidly,  the  blood  and  lymph  in  the 
crater  are  resorbed,  and  from  its  walls  there  forms  a  char- 
acteristic tissue,  known  as  the  corpus  luteum  of  estrum. 


22  Diseases  of  the  Geyiital  Organs 

In  the  cow  and  in  most  other  animals  it  is  identical  in  form, 
consistence,  and  volume  with  the  corpus  luteum  of  preg- 
nancy, but  its  color  differs.  In  the  non-pregnant  cow  it  is 
chocolate-colored.    Prior  to  the  next  estrum  it  atrophies. 

Should  the  ovum  become  fecundated  and  undergo  normal 
development,  the  corpus  luteum  forming  in  the  crater  is  al- 
most always  markedly  yellow,  lemon,  or  orange.  It  pro- 
jects beyond  the  ovarian  surface.  It  persists  regularly  up 
to  the  time  of  parturition  or  abortion  and  for  a  varying 
length  of  time  thereafter.  It  is  known  as  a  true  corpus 
luteum.  Pathologically,  it  sometimes  atrophies  during 
pregnancy  and  is  one  of  the  causes  of  estrum  in  pregnant 
animals.  While  in  unipara  the  corpus  luteum  regularly 
atrophies  soon  after  the  termination  of  pregnancy,  the 
atrophy  is  ordinarily  dependent  upon  the  expulsion  of  the 
uterine  contents.  If  the  fetus  perishes,  but  is  retained  and 
desiccates  or  macerates,  the  corpus  luteum  remains.  In 
the  sow  (and  presumably  in  other  multipara)  the  number 
of  corpora  lutea  almost  always  exceeds  the  number  of 
fetuses,  both  living  and  dead,  registering  the  fact  that  not 
all  ova  discharged  at  a  given  estrum  successfully  mature. 
When  very  few  pigs  are  born  in  a  litter,  it  indicates  that 
numerous  ova  or  embryos  have  perished,  rather  than  that 
few  ova  were  discharged.  The  size  and  form  of  the  ovary 
are  accordingly  modified  by  the  presence  of  a  ripe  ovisac 
or  ovisacs  or  of  a  corpus  luteum.  In  the  cow  the  corpus 
luteum  is  frequently  larger  than  the  remainder  of  the 
ovary — approximately  %  to  %  inch. 

2.    The  Muellerian  Ducts 

The  beginning  of  the  genital  canal  in  the  embryo  con- 
sists of  two  parallel  rods,  which  later  become  excavated  to 
form  tubes — the  ducts  of  Mueller — extending  from  near 
the  posterior  body  opening,  upward  and  forward  to  the  re- 
gion of  the  ovary.  Eventually  the  two  ducts  fuse  at  their 
posterior  ends,  producing  a  single  tube.  The  ducts  become 
differentiated,  through  specialization  in  their  development, 
into  four  essentially  separate  segments,  each  having  its 
distinctive  function.     The  anterior  segment  constitutes  the 


The  Miielleriayi  Diicts  23 

oviduct,  or  Fallopian  tube,  dilated  at  its  anterior  end  to 
form  the  ampulla,  or  pavilion.  The  oviduct  constitutes  a 
conduit  through  which  the  spermatozoa  of  the  male  may 
pass  from  the  vagina  and  uterus  to  the  ampulla,  there  to 
meet  and  fertilize  the  freshly  discharged  ovum.  It  serves 
later  to  transport  the  ovum,  fertilized  or  unfertilized,  to 
the  uterus.  The  second,  or  middle  portion  of  the  genital 
tube  constitutes  the  uterine  cavity,  including  the  cornua, 
in  which  the  fetus  may  find  lodgment,  attachment,  nutri- 
tion, and  protection  during  its  development.  The  third 
segment  consists  of  the  cervix,  which  acts  as  a  barrier  be- 
tween the  uterus  and  the  vagina.  The  fourth,  or  posterior 
segment — the  vagina — extending  from  the  uterus  to  the 
vulva,  serves  first  as  an  essential  copulative  organ  and  later 
as  a  passage  for  the  fetus  at  the  time  of  birth. 

The  degree  of  the  fusion  of  the  Muellerian  ducts  and  the 
extent  of  the  specialization  of  the  different  areas  modify 
greatly  the  form  and  relations  of  the  various  segments. 
The  entire  genital  tube,  having  a  common  embryonic  origin, 
has  a  similar  structure,  characterized  chiefly  by  three  coats 
— peritoneal,  muscular,  and  mucous.  The  peritoneal  layer, 
which  invests  the  genital  tract  almost  completely,  is  derived 
from  the  peritoneum  of  the  body  wall,  behind  which  the 
ducts  of  Mueller  originate.  At  its  anterior  extremity  the 
genital  tract  opens,  through  the  pavilion  of  the  oviduct, 
into  the  peritoneal  cavity.  The  peritoneum  stops  at  the  mar- 
gin of  the  pavilion,  to  be  succeeded  by  the  mucous  membrane 
of  the  oviducts 

The  genital  tract  is  supported  by  the  broad  ligaments, 
which  consist  of  two  peritoneal  layers  resulting  from  the 
departure  of  the  genital  tube  from  its  seat  of  origin  behind 
the  peritoneum.  Along  the  line  of  their  attachment  to  the 
genital  tube,  the  peritoneal  investment  is  interrupted  to  the 
extent  of  the  area  between  the  two  peritoneal  folds  occupied 
by  the  vessels,  nerves,  pale  muscle,  and  connective  tissue 
fibres  constituting  the  body  of  the  ligament.  At  the  pos- 
terior extremity  of  the  genital  tract,  where  it  opens  into 
the  cloaca  of  the  embryo,  the  peritoneum  is  reflected  upon 


24 


Diseases  of  the  Genital  Orgaiis 


neighboring  organs  and  the  genital  tube  is  surrounded  by 
the  intra-pelvic  connective  tissue,  so  that  eventually  the 
peritoneum  covers,  in  addition  to  the  oviducts  and  uterus, 
only  the  more  anterior  portions  of  the  vagina.  The  fusion- 
of  the  two  Muellerian  ducts,  to  form  the  vagina  and  uterus, 
destroys  the  contiguous  median  walls  of  the  tubes  as  far  as 
they  coalesce,  and  the  adjacent  tubes  become  a  single  canal. 
The  broad  ligament  of  the  uterus  varies  greatly  in  its  form 
and  amplitude  acording  to  species  and  the  functional  activity 
of  the  genital  tract.  In  the  bitch,  cat,  and  sow,  in  which  the 
anterior  extremities  of  the  uterine  cornua  remain  through- 
out the  life  of  the  animal  about  as  far  forward  as  the  post- 
erior border  of  the  kidney,  the  broad  ligament  maintains  its 
anterior  attachment  to  the  abdominal  wall  at  or  near  the 
point  of  origin  of  the  ovary  just  behind  the  kidney;  in  the 
ruminant,  where  the  ovary  and  the  anterior  ends  of  the 
uterine  cornua  are  turned  backward  to  the  immediate 
vicinity  of  the  internal  inguinal  ring,  the  parietal  attach- 
ment of  the  anterior  border  of  the  ligament  likewise  moves 
backward  for  a  considerable  distance  so  that  the  middle  of 
the  recurved  cornu  tends  to  project  forward  beyond  the  an- 
terior margin  of  the  ligamentous  attachment.  When  the 
uterus  of  a  quadrupedal  mammal  becomes  gravid,  the  weight 
of  the  fetus  drags  the  occupied  portion  downward  and  for- 
ward until  the  organ  comes  to  rest  upon  the  abdominal  floor 
in  front  of  the  anterior  point  of  fixation  of  the  ligament  to 
the  abdominal  wall.  The  genital  tube  is  further  maintain- 
ed in  its  position  by  its  attachment  posteriorly  to  the  vulva 
and  also  by  the  round  ligament  of  the  uterus. 

The  muscular  walls  of  the  genital  tube  are  composed  of 
circular  and  longitudinal  layers  of  pale  fibres,  varying 
greatly  in  the  different  sections  of  the  tract  and  also  accord- 
ing to  whether  the  animal  be  pregnant  or  not. 

The  mucous  coat  of  the  genital  tract  offers  the  greatest 
possible  variations  and  assumes  widely  differing  and  highly 
important  functions,  according  to  the  particular  area  con- 
cerned. 


The  Muelleriayi  Ducts  25 

a.  The  oviducts,  formed  from  the  anterior  or  ovarian  ex- 
tremities of  the  Muellerian  ducts,  are  two  long,  tortuous 
tubes,  varying  in  length  and  other  characters  according  to 
species.  Their  length  is  much  greater  than  the  distance 
from  the  anterior  extremity  of  the  uterine  cornu  to  the 
ovary.  This  distance  is  fixed  by  the  utero-ovarian  liga- 
ment. In  some  animals  the  oviducts  are  naked  and  clearly 
visible.  In  the  bitch  they  are  hidden  in  the  abundant  fat 
of  the  broad  ligament.  The  utero-ovarian  ligament  in  the 
dog  and  cat  is  very  short,  so  that  the  anterior  end  of  the 
uterine  cornu  is  virtually  in  contact  v^ith  the  ovary,  while 
the  oviduct,  3  to  4  inches  in  length,  is  thrown  into  numerous 
folds,  to  terminate  in  the  immediate  region  of  its  origin,  so 
that  casual  observation,  without  dissection,  might  lead  to  the 
assumption  that  the  oviduct  was  well-nigh  absent,  whereas 
it  is  very  similar  in  actual  length  to  that  of  other  species. 
When  divested  of  any  concealing  coverings  of  peritoneum, 
fat,  or  other  tissues,  the  oviduct  appears  as  a  very  convo- 
luted white  cord  about  0.1  inch  in  diameter.  It  is  very  firm 
to  the  touch  and  gives  a  sensation  much  like  its  analogue 
in  the  male,  the  vas  deferens.  After  it  is  dissected  out  from 
the  surrounding  tissues  and  its  numerous  abrupt  curves  are 
carefully  eliminated,  a  very  fine  sound,  as  one  of  the  tail 
hairs  of  a  horse,  may  be  inserted  at  one  opening  and  passed 
through  its  entire  length.  While  technically  the  oviducts 
complete  a  communication  between  the  peritoneal  cavity  and 
the  exterior,  the  tubes  are  ideally  impassable,  except  to  ova 
and  spermatozoa.  They  do  not  under  usual  conditions  per- 
mit the  forcing  of  liquids  through  their  canal  when  intra- 
uterine injections  are  made  under  comparatively  high  pres- 
sure. Clinically,  they  also  offer  valuable  resistance  to  the 
passage  of  bacteria.  Frequently,  pathogenic  organisms, 
such  as  those  involved  in  abortion  and  retained  placenta  in 
cows  and  other  animals,  travel  along  the  oviducts,  causing 
disease  of  them  or,  reaching  the  ovary,  induce  abcess  or  other 
disease,  causing  sterility. 

The  intimacy  of  contact  between  the  peritoneal  covering 
of  the  oviduct  and  the  muscular  walls  varies  according  to 


26  Disea9.es  of  the  Genital  Organs 

species.  The  investment  is  very  close  in  ruminants  and  the 
sow,  so  that  the  ducts  are  readily  seen  without  dissection. 
In  the  mare  the  duct  is  surrounded  by  much  connective 
tissue,  which  serves  to  conceal  it  from  view  until  the  peri- 
toneal and  fibrous  coverings  are  dissected  away.  In  the 
bitch  the  concealment  is  further  accentuated  by  large 
amounts  of  adipose  tissue. 

The  oviduct  opens  anteriorly  through  the  ostium  abdomi- 
nale  into  the  pavilion  of  the  tube  and  posteriorly  into  the 
uterine  cornu  through  the  ostium  uterinum,  which  usually 
projects  somewhat  as  a  small  eminence  into  the  cavity  of 
the  cornu. 

The  muscular  coat  of  the  oviducts  is  characterized  chiefly 
by  its  density,  which  gives  to  it  an  almost  cartilaginous  con- 
sistency, and  its  paleness,  which  amounts  almost  to  trans- 
lucency.  The  superficial  layer  of  the  mucosa  of  the  oviducts 
consists  of  ciliated  columnar  epithelium  with  the  cilia  vi- 
brating toward  the  uterus.  The  oviduct  is  the  most  rigid 
and  undilatable  portion  of  the  genital  tube.  It  provides 
passage  for  the  migration  of  the  spermatozoa  of  the  male, 
which,  in  spite  of  the  movements  of  the  cilia  in  the  contrary 
direction,  advance  from  the  uterus  toward  the  ovary,  in 
virtue  of  their  inherent  power  of  movement,  meet  the  ovum 
in  the  pavilion,  and  fecundate  it.  Later  the  oviduct  conveys 
the  ovum,  fecundated  or  not,  from  the  ovary  to  the  uterus. 
In  this  function  the  cilia  play  an  essential  part.  In  rare 
cases  the  fecundated  ovum  lodges  in  the  duct  and  under- 
goes partial  development,  to  constitute  tubal  pregnancy,  but 
the  undilatability  of  the  duct  serves,  as  a  rule,  to  cause  a 
rupture  of  its  walls  and  leads  to  the  escape  of  the  fetus  from 
the  duct  into  the  peritoneal  cavity,  either  to  cause  sudden 
death  of  the  mother  from  hemorrhage  or  to  constitute  extra- 
uterine, or  abdominal,  pregnancy. 

b.  The  uterus,  see  Figs.  12,  13,  a  bifurcated,  musculo- 
membranous  sac,  designed  for  the  reception,  nutrition,  and 
protection  of  the  ovum,  finally  takes  the  initial  part  in  the 
expulsion  of  the  fetus  at  the  time  of  birth.  The  uterus 
varies  greatly  in  form  and  disposition,  dependent  partly 


77^1?  I\Uiellerian  Diicts  27 

upon  the  degree  of  fusion  which  has  occurred  between  the 
two  tubes.  There  are  recognized  in  domestic  animals  a 
uterine  body  and  two  cornua,  each  having  essentially  like 
functions  in  varying  degrees.  This  is  in  sharp  contrast  to 
the  uterus  of  woman,  where  the  uterine  body  constitutes  es- 
sentially the  entire  functional  organ  and  the  cornua  are  un- 
important appendages.  In  the  rabbit  there  is  no  uterine 
body,  but  two  distinct  tubular  uteri  opening  separately  into 
the  vagina.  In  the  bitch,  cat,  and  sow  the  uterine  body  is 
limited  in  extent  and  physiologically  unimportant,  rarely 
containing  placental  attachments  and  only  a  small  portion 
of  one  fetus  except  while  in  transit  at  the  time  of  birth. 
The  two  cornua  are  extensive,  and  in  them  develop  the 
fetuses,  so  that  physiologically  the  horns  represent  the  two 
separate  uteri  of  the  rabbit.  In  ruminants  the  uterine  body 
is  larger  and  assumes  higher  importance  physiologically, 
while  the  cornua  remain  relatively  large.  The  one,  two,  or, 
very  rarely,  more  fetuses  are  habitually  located  almost 
equally  in  the  body  and  the  cornua,  so  that  they  represent  a 
middle  stage  in  the  transition  between  the  double  uterus  of 
the  rabbit  and  the  single  uterus  of  woman,  physiologically 
devoid  of  cornua.  In  the  mare  the  uterine  body  becomes  re- 
latively more  important  than  in  the  ruminant. 

The  relative  sizes  of  the  cornua  and  of  the  uterine  body 
bear  a  close  relation  to  the  number  of  young  brought  forth 
at  a  given  birth.  In  multiparous  animals,  there  are  two 
uteri,  as  in  the  rabbit,  or  the  two  extensive  cornua  with 
functionally  unimportant  uterine  body,  as  in  the  bitch,  cat, 
and  sow.  In  ruminants,  which  are  largely  biparous,  the 
uterine  body  and  cornua  become  approximately  equal  in  ex- 
tent and  function.  In  the  normally  uniparous  mare,  the 
cornua  are  smaller  than  the  body. 

The  uterus  and  its  cornua,  within  the  above  limitations, 
are  uniform  in  their  plan  of  structure  and  function.  They 
consist  of  three  coats :  mucous,  muscular  and  peritoneal. 

The  mucous  coat  constitutes  the  essential  physiologic  basis 
of  the  organ.  The  mucous  epithelium  is  very  elaborate,  con- 
sisting superficially  of  columnar  cells,  embedded  deeply  with- 


28 


Diseases  of  the  Genital  Organs 


in  which  are  numerous  tubular  structures  of  a  glandular 
character,  the  utricular  glands,  believed  to  secrete  the  so- 
called  uterine  milk,  which  is  presumed  to  play  an  important 
role  in  the  nutrition  of  the  ovum  pending  the  f ormation^  of 
the  embryo  and  the  establishment  of  its  intricate  connection 


°^  fk 


o 


r^ 


4 


uc 


i  ^ 


W- 


BL 


J 


Pio.   1 2— Non- gravid  Uterus  of  Mare  viewed  from  the  Dorsal  Surface. 

O,  (->,  Ovarv  ;   (^^r:  oviduct ;    /'.uterus;    / 'C   uterine  cornu  ;    BL,    broad 
ligament  ;    I'',  vagina  ;    I'it,  vulva  ;   C7,  clitoris  ;  //,  hymen. 

with  the  mucous  membrane  through  the  chorion.  Yet  more 
important,  it  is  through  a  special  elaboration  of  the  uterine 
mucosa  that  the  highly  intricate  and  essential  maternal 
placenta  is  formed,  to  constitute  a  physical  and  physiologic 


The  Miiellerian  Duds  29 

bond  between  the  mother  and  fetus  during  the  span  of  preg- 
nancy. The  uterine  mucosa  is  presumed  to  exert  important 
bactericidal  powers,  but  a  majority  of  uteri  of  cows,  both 
pregnant  and  non-pregnant,  contain  bacteria,  several  of 
which  appear  competent  to  induce  important  disease  (steril- 
ity, abortion).  In  the  non-gravid  uterus,  as  is  common 
with  distensible  hollow  organs,  the  mucous  membrane  is 
thrown  into  numerous  longitudinal  folds,  which  facilitate 
prompt  and  extensive  dilation  of  the  cavity  without  violence. 

The  muscular  coat  consists  of  two  somewhat  differentiable 
groups  of  longitudinal  and  circular  pale  muscle  fibers  which 
increase  during  pregnancy  in  size,  activity,  and,  it  is  be- 
lieved, to  some  extent  in  number.  The  proportion  of  the 
longitudinal  to  the  circular  fibres  varies. 

The  peritoneal  layer  of  the  uterus,  which  is  derived  from 
that  of  the  abdominal  walls,  envelops  the  organ  completely 
except  at  the  points  of  continuity  with  the  oviducts  and 
vagina  and  the  interstice  between  the  two  peritoneal  sheets 
of  the  broad  ligament  at  their  points  of  uterine  attachment. 

The  uterus  is  retained  in  position  by  its  broad  ligaments 
and  by  its  continuity  anteriorly  with  the  oviducts  and  pos- 
teriorly with  the  cervix.  The  round  ligament  of  the  uterus, 
arising  from  the  skin,  or  dartos,  in  the  region  normally 
constituting  the  fundus  of  the  scrotum  in  the  male,  and 
passing  up  through  the  inguinal  canal  and  abdominal  ring 
and  thence  to  the  cornu,  or  oviduct,  is  functionally  of  scant 
interest  as  a  ligament  of  fixation.  The  uterus  is  located 
immediately  beneath  the  rectum,  with  its  two  cornua  pass- 
ing obliquely  outward  and  forward  on  either  side. 

The  uterus  of  the  mare,  with  its  cornua,  constitutes  a 
somewhat  crucial  organ :  the  horns  leave  the  body  laterally 
at  right  angles  or  somewhat  recurved.  The  uterine  body 
is  oblong,  flattened  somewhat  from  above  to  below,  varying 
from  5  to  8  inches  in  length  and  II/2  to  2V2  inches  in  width. 
Anteriorly,  the  cavity  of  the  uterine  body  of  the  mare  is 
continuous  with  that  of  the  two  cornua,  without  a  distinct 
line  of  demarcation  beyond  an  abrupt  turn  at  right  angles 
or  slight  recurvation  to  its  long  axis.     Each  cornu  is  much 


30 


Diseases  of  the  Genital  Orgayis 


like  the  body.  The  cavity  of  each  is  essentially  equal  to 
that  of  the  body,  and  the  combined  length  of  the  two  is 
greater  than  that  of  the  body.  They  end  obtusely  not  far 
from  the  ovary.  Each  presents  at  its  apex  a  conical  pro- 
jection in  which  there  is  an  opening,  the  os  uterinum,  or 
uterine  orifice  of  the  oviducts. 


Fig.  13 — Ovaries,  Oviducts,  Uterus,  and  Cervix  of  Cow. 

/,  Os  uteri  extern iiiii  ;  2,  right  cormi;   9,  ovary  ;  ./,  ovarian  vcntrick'  ;  j,  osliuin 
abdoniinale  of  the  oviduct,  6. 


The  Muellerian  Ducts 


31 


The  peculiar  crucial  form  of  the  uterus  of  the  mare — the 
two  ample  horns  with  the  bases  of  their  cavities  directly 
opposite,  so  that  they  have  a  common  long  axis — renders 


RUG 


Fig.  14—  Genital  Organs  of  the  Bitch. 
T,  T,  Posterior  teat  ;  B,  urinary  bladder  ;    V,  vagina  ;    U,  uterus  ;    Z.f/C_left   uterine 
cornu  with  a  portion  of  the  broad  ligament,  BL,    lying  across  it ;    RUC,   right   uterine 
cornu  with  its  broad  ligament,  BL\  turned   outward  exposing  the   full   length   of  the 
cornu  ;  O,  O,  ovary  ;  A*,  rectum  ;  /t,  left  kidney. 


32  Diseases  of  tlie  Ge7iital  Organs 

bicornual,  or  transverse  pregnancy  so  easy  that  it  occurs 
not  infrequently,  resulting  in  a  variety  of  transverse  presen- 
tations and  causing  some  of*  the  most  serious  dystocias 
known  to  the  veterinary  practitioner. 

In  ruminants  the  uterine  body  is  less  pronounced  in  size, 
when  viewed  exteriorly,  and  even  less  upon  section,  while 
the  cornua  are  much  longer,  quite  tapering,  and  compara- 
tively more  ample  than  in  the  mare.  The  two  cornua  sep- 
arate at  a  very  acute  angle,  for  a  time  extend  forward  al- 
most parallel  to  each  other,  and  then,  becoming  somewhat 
more  divergent,  curve  downward,  outward,  backward,  and 
finally  upward,  to  end  alongside  the  cervix  within  the  pelvis. 
The  uterine  body  and  cornua  are  much  denser,  narrower, 
and  more  cylindrical  than  in  the  mare.  The  cornua  taper 
gradually  from  their  bases  at  the  uterine  body  to  their 
apices,  where  they  pass  almost  insensibly  into  the  oviducts. 

The  broad  ligaments  of  the  uterus  of  the  mare  arise 
from  the  abdominal  walls  in  the  sublumbar  region,  begin- 
ning not  far  posterior  to  the  kidneys  and  extending  from 
this  point  obliquely  downward,  backward,  and  medianward 
into  the  pelvic  cavity,  where  the  two  layers  of  peritoneum 
become  reflected  from  the  vagina  upon  the  bladder,  rectum, 
and  pelvic  walls.  Compared  with  the  broad  ligaments  of 
other  domestic  animals,  they  are  limited  in  extent,  especial- 
ly transversely,  causing  a  comparatively  rigid  fixation  of 
the  uterus,  and,  since  their  anterior  attachment  is  approxi- 
mately in  a  direct  line  with  the  long  axis  of  the  cornua,  the 
entire  organ  is  held  well  forward  in  the  abdominal  cavity. 

The  broad  ligaments  of  ruminants,  as  compared  with 
those  of  the  mare,  are  much  more  ample  transversely,  while 
antero-posteriorly  they  are  much  less  extensive.  Their  an- 
terior point  of  attachment  to  the  abdominal  parietes  is 
much  farther  posterior  than  in  the  mare.  This  variation 
in  disposition  and  relations  of  the  broad  ligament  produces 
two  well-marked  clinical  diff"erences.  In  the  non-gravid 
uterus  of  the  cow,  the  anterior  parietal  attachment  of  its 
broad  ligament  is  already  posterior  to  the  anterior  curva- 
ture of  the  uterine  cornua,  which  in  the  gravid  uterus  be- 


The  Miiellerian  Ducts  33 

comes  sharply  accentuated,  so  that  almost  the  entire  organ 
rests  anterior  to  its  ligamentous  attachments  to  the  ab- 
dominal parietes.  In  the  cow  and  ewe,  the  broad  ligaments 
become  largely  powerless  in  preventing  the  pregnant  organ 
from  revolving  upon  its  long  axis,  so  that  torsion  of  the 
uterus  becomes  quite  common,  while  in  the  mare  the  more 
rigidly  fixed  organ,  with  the  anterior  parietal  attachment 
of  the  ligament  much  farther  forward,  serves  to  render  the 
displacement  comparatively  rare.  In  ruminants,  the  com- 
parative amplitude  of  the  ligaments,  with  their  anterior 
point  of  parietal  attachment  but  little  anterior  to  the  pelvic 
inlet,  permits  more  readily  than  in  other  animals  inversion 
and  prolapse  of  the  uterus  and  vagina. 

In  multiparous  animals  the  broad  ligaments  are  neces- 
sarily very  extensive  and  uniformly  have  their  anterior 
point  of  attachment  to  the  abdominal  walls  far  forward  in 
the  post-renal' region.  In  the  bitch,  the  ligament  at  its  an- 
terior border  is  very  short,  so  that  the  ovary  and  ovarian 
end  of  the  cornu  are  closely  fixed  in  the  sublumbar  region, 
just  posterior  to  the  kidney,  tending  to  stretch  the  cornu  be- 
tween this  anterior,  sublumbar  attachment  and  the  vagina. 
The  ligaments  are  exceedingly  ample,  except  at  the  anterior 
border,  and  are  much  broader  than  the  distance  from  the 
parietal  attachments  to  the  position  of  the  cornu,  resulting 
in  a  large  antero-posterior  fold  in  the  ligament,  which  drops 
down  on  the  lateral  side  of  the  cornu  and  covers  it  in  a 
double  fold  of  broad  ligament  (Fig.  14).  Unlike  other  do- 
mestic animals,  the  broad  ligaments  of  the  bitch  are  uni- 
formly the  seat  of  extensive  deposits  of  fat,  which  cause 
them  to  resemble  the  gastric  omentum  in  general  ap- 
pearance. 

c.  The  cervix,  or  neck  of  the  uterus,  consists  of  a  power- 
ful, sphincter-like  segment  of  the  genital  tract,  serving  to 
separate  anatomically  and  physiologically  the  uterus  from 
the  vagina.  It  is  continuous  anteriorly  with  the  uterine 
body  and  posteriorly  with  the  vagina.  It  is  a  tubular  organ 
having  walls  very  much  thicker  than  those  of  the  uterus  or 
vagina  and  very  dense  and  rigid.     In  the  cow  especially  the 


34 


Diseases  of  the  Genital  Organs 


walls  are  intensely  rigid  and  hard  like  cartilage.  In  rigid- 
ity the  cervix  is  closely  analogous  to  the  oviducts.  In  func- 
tion, too,  they  are  analogous:  the  one  acts  as  a  powerful 
guardian  of  the  anterior,  or  peritoneal  opening  of  the 
uterus;  the  other  of  the  posterior,  or  vaginal  portal.  The 
cervix  varies  in  size  in  the  different  genera  and  in  individ- 
uals. The  posterior  end  of  the  cervix  projects  into  the 
vagina  as  an  obtuse  cone,  II/2  to  21/2  inches  in  the  mare  and 


Fig.  15 — Cervices  of  Virgin  Heifers  opened  from  above  on  the 
median  line  exposing  the  Annular  Folds  of  the  Mucosa. 

/,  First  or  vaginal  fold  ;    2,  j,  7,  the  second,  third  and  fourth  folds  respectively. 

the  cow.  The  cow  has  the  longest  and  most  powerful 
cervix:  it  is  3  to  5  inches  antero-posteriorly  and  2  to  3 
inches  transversely.  Its  muscular  walls  are  so  rigid,  and 
its  circular  muscle  fibres  so  contracted  that  it  is  exceedingly 
difficult  to  dilate  the  canal  mechanically,  but  it  dilates  freely 
under  the  influence  of  estrum  and  parturition.  The  cervix 
of  the  mare  is  shorter  than  that  of  the  cow  and  the  walls 
far  thinner  and  more  pliable,  rendering  its  canal  readily 
dilatable. 


The  Miiellerian  Duds 


35 


The  cervical  mucosa  is  very  complex.  It  is  thrown  into 
deep  and  ample  longitudinal  folds,  which  upon  cross  section 
(See  Figs.  16  and  17)  are  seen  to  radiate  centralward  from 
the  basal  mucosa,  the  summits  of  the  rugae  converging  to 
meet  at  the  central  axis  of  the  cervical  canal.  The  cervical 
mucosa  of  the  ruminant  is  also  thrown  into  very  ample  cir- 


FiG.  i6  (Above)  and  Fig.  17  (Below). 
Transverse  section  of  the  cervix  between  the  Annular  Folds. 
Fig.  16— Viewed  from  the  uterine  end.  From  left  to  right  they  represent  the  first, 
second,    third,    and  fourth  annular  rings   respectively.      A,   Cervical  canal ;  M. 
muscular  wall  of  cervix. 

Fig.  17 — Annular  folds  \iewed  from  the  vaginal  end. 


36  Diseases  of  the  Genital  Organs 

cular  folds,  with  their  summits,  or  free  surfaces,  directed 
vaginalward.  In  the  cow  these  circular  folds  measure  one- 
half  to  three-fourths  of  an  inch  from  the  base  to  the  free 
summit,  and  in  disease  may  become  elongated  to  several 
inches  and  protrude  into  the  vagina  to  constitute  large 
polypoid  masses.  The  cervical  mucosa  is  rich  in  special 
mucous  glands,  which  during  pregnancy  elaborate  the 
uterine  seal — a  very  tough,  firm,  adhesive  structure  com- 
pletely sealing  the  cervical  canal  from  the  uterus  to  the 
vagina  and  constituting  a  highly  elaborate  and  efficient  bar- 
rier against  invasion  of  the  pregnant  uterus  by  infection 
from  the  vagina.  The  cervical  canal,  elaborately  barri- 
caded by  mucous  folds  and  by  the  firm  contraction  of  the 
circular  muscles,  is  extremely  narrow,  and  in  the  ruminant 
is  besides  exceedingly  crooked  (See  Figs.  40,  41),  This 
disposition  of  the  cervical  mucosa  has  given  rise  in  the  past 
to  the  fiction  of  "closure  of  the  womb"  and  led  to  the  belief 
in  "opening  the  womb"  as  a  panacea  in  sterility.  Anterior- 
ly, the  cervical  canal  opens  into  the  uterine  cavity  by  the  os 
uteri  internum;  posteriorly,  at  the  summit  of  the  conical 
projection  into  the  vagina  by  the  os  uteri  externum. 

During  estrum  the  muscular  walls  of  the  cervix  relax  and 
the  cervical  canal  dilates  somewhat.  When  parturition  en- 
sues, the  cervix,  as  such,  becomes  temporarily  obliterated, 
and  the  canal  dilates  sufficiently  for  the  passage  of  the  fetus 
-^that  is,  until  its  cavity  is  co-extensive  with  the  pelvic  cav- 
ity and  \\7th  the  cavities  of  the  uterus  and  vagina.  At  this 
time  it  becomes  virtually  non-recognizable ;  all  the  posterior 
segments  of  the  genital  tract — uterus,  cervix,  and  vagina 
— become  one  continuous  tube  of  virtually  uniform  calibre. 
In  that  type  of  cystic  disease  of  the  ovaries  causing  nymph- 
omania, the  cervical  canal  undergoes  pathologic  dilation. 
In  the  sow  the  cervix  is  not  so  well  defined  and  no  elaborate 
uterine  seal  forms.  Instead,  the  vagina  and  cervix  extend 
as  an  irregular  tube  up  to  the  bifurcation  of  the  essentially 
double  uterus. 

d.  The  vagina  is  a  musculo-membranous  canal,  formed 
from  the  fusion  of  the  posterior  ends  of  Mueller's  ducts  and 


The  Miiellcrian  Ducts 


Fig.  iS.     Vulva  and  Vagina  of  Cow  showing  Gartner's  Ducts. 
A,  Os  uteri  externum  ;    /,  meatus  urinarius ;    2,  the  outlets  of  the  two  ducts  of 
Gartner.     The  arrows  point    to  small  openings  from  the  duct  into  the  vagina, 
apparently  from  ruptures  of  small  cysts  or  abscesses, 


38  Diseases  of  the  Genital  Organs 

extending  from  the  cervix  to  the  vulva.  It  begins  at  the  os 
uteri  externum  and  ends  posteriorly  at  the  position  of  the 
hymen,  just  anterior  to  the  meatus  urinarius,  where  the 
vulva  succeeds  it.  In  the  cow,  incomplete  fusion  of  the 
Muellerian  ducts  in  the  vaginal  segment  is  evidenced  oc- 
casionally by  a  muscular  column  of  varying  size  stretching 
from  the  roof  to  the  floor  of  the  vagina  on  the  central  line, 
just  against,  but  free  from  the  vaginal  end  of  the  cervix. 

The  vagina  of  the  mare  is  eight  to  twelve  inches  in 
length  and  capable  of  lateral  distension  to  the  full  size  of  the 
pelvic  cavity.  It  is  lined  with  squamous  epithelium.  Its 
mucosa  is  thrown  into  longitudinal  folds,  which,  when  at 
rest,  lie  in  contact  with  each  other. 

The  mucous  membrane  of  the  vagina  has  in  its  deeper 
portions  numerous  mucous  glands  which  serve  to  keep  the 
surface  at  all  times  moist  and  which  become  especially  ac- 
tive during  sexual  excitement  and  at  the  close  of  pregnancy. 
The  muscular  coat  does  not  differ  fundamentally  in  arrange- 
ment from  that  of  the  uterus,  though  less  in  volume. 

In  the  mare,  the  peritoneal  covering  extends  backward 
from  the  anterior  extremity  three  to  five  inches,  where  it 
becomes  reflected  upon  the  rectum,  bladder,  and  pelvic  walls. 
In  the  posterior  portion  of  its  course,  the  vagina  is  sur- 
rounded by  the  loose  pelvic  connective  tissue,  which  permits 
comparatively  free  movement. 

The  function  of  the  vagina  is  chiefly  copulative,  receiving 
the  penis  of  the  male  during  coition.  During  parturition, 
it  affords  a  passage  for  the  fetus  from  the  uterus  to  the 
vulva. 

In  the  mare  and  the  cow  the  vagina  frequently  becomes 
ballooned  during  manual  exploration  of  the  organ,  owing  to 
an  inflow  of  air  at  the  moment  of  inspiration.  During  ex- 
ploration the  vulva  is  propped  open  by  the  hand  or  arm  of 
the  operator,  permitting  the  air  to  flow  in,  distending  the 
vagina  so  that  it  fills  the  pelvic  cavity  completely  from  side 
to  side  and  from  roof  to  floor,  presenting  a  vast  cavity  with 
smooth,  rigid  walls,  which  are  in  close  contact  laterally  with 
the  bony  or  ligamentous  pelvic  walls,  superiorly  with  the 


The  M Heller ian  Ducts  39 

sacrum  except  in  the  area  where  the  rectum  intervenes,  and 
inferiorly  with  the  pubis  except  for  the  urinary  bladder. 
The  ballooning  of  the  vagina  of  the  mare  or  the  cow  is 
readily  induced  by  intra-vaginal  manipulation,  by  the  in- 
jection into  the  organ  of  bland,  tepid  fluids,  or  by  various 


Fic.   19.     Vulva  and  Vagina  of  Cow  Showing- Gartner's 
Ducts  and  Bartholin's  Glands. 
/,  Meatus  urinarius  ;    2,  j,   cj'stic  areas  in  the  right  duct  of  Gartner  ;  ^, 
cervical  canal  laid  open  ;  C,  small  cyst  in  Bartholin's  gland. 

other  means.  When  the  moist  hand  is  introduced  into  the 
organ  at  the  time  of  estrum,  marked  inflation  generally  oc- 
curs at  once. 

e.     Gartner's  Ducts.     The  Wolffian  ducts  of  the  embryo 
do  not  wholly  disappear  in  the  female  but  persist  in  varying 


40  Diseases  of  the  Genital  Organs 

degrees  as  essentially  functionless  structures.  The  caudal 
ends  of  the  ducts  persist  as  recognizable  structures  along 
the  floor  of  the  vagina  in  the  cow.  They  end  posteriorly 
just  in  front  of  the  meatus  urinarius  where  they  lie  near 
together.     They  consist  of  very  fine  tubes  which  diverge 


Fig.  20.     Vulva  and  Vagina  of  Cow. 
/,  Meatus  urinarius  ;  2,  2,  enlarged  openings  of  Gartner's  duct  in  which  a 
wire  loop  has  been  inserted  ;   j,  opening  of  Barlholin's  gland  ;  4,  cervix. 
The  conrse  of  Gartner's  ducts  is  indicated  by  arrows  ujion  slight  ridges. 

slightly  as  they  pass  forward  to  disappear  to  the  right  and 
left  of  the  cervix.  As  a  result  of  vaginitis,  their  orifices 
occasionally  become  occluded  and  the  structures  assume  the 
character  of  cylindrical  or  spindle-shaped  retention  cysts. 
(See  Figs.  18,  19,  20,  21.) 


The    Vidva  4 1 

3.    The  Vulva 

The  vulva,  located  immediately  beneath  the  anus,  consti- 
tutes the  posterior  termination  of  the  genital  canal.  In- 
stead of  being  derived  from  the  mesodermic  Muellerian 
ducts  like  the  preceding  organs,  the  vulvar  epithelium  origi- 
nates from  the  ectoderm  of  the  embryo. 

Anteriorly,  the  boundary  between  the  vagina  and  the  vulva 
is  marked  by  the  hymen,  a  transverse  membranous  expanse 
stretching  across  the  genital  canal,  v^hich  represents  the 
partition  between  the  termination  of  the  hind  gut  and  the 
proctodeum  of  the  embryo,  in  the  lower,  or  genito-urinary, 
division  of  the  cloaca.  Generally  it  atrophies  and  almost  or 
wholly  disappears  in  domestic  animals  before  birth,  but  at 
times  it  persists,  either  as  vertical  bands  stretching  across 
from  the  roof  to  the  floor  of  the  vagina  or  as  a  circular  ex- 
panse largely  closing  the  genital  canal  except  in  its  center. 
Rarely  in  domestic  animals  the  hymen  persists  as  an  im- 
pervious membrane. 

The  vulva  opens  externally  by  means  of  a  vertically  elong- 
ated slit,  bounded  upon  either  side  by  the  labiae  vulvae, 
which  meet  above  and  below  to  form  the  superior  and  in- 
ferior vulvar  commissures. 

The  vulvar  labiae  are  covered  externally  by  a  very  fine 
skin.  In  the  mare  the  growth  of  hairs  is  inconspicuous ;  in 
the  cow,  there  is  a  prominent  tuft  of  hairs  about  the  in- 
ferior commissure.  The  parts  are  so  scantily  haired  that 
their  color,  which  as  a  rule  is  simply  that  of  the  adjacent 
skin,  becomes  very  conspicuous.  In  dark-skinned  mares 
with  white  faces,  eyes,  and  feet,  the  cutaneous  covering  of 
the  vulva  tends  also  to  be  devoid  of  pigment.  The  promi- 
nence of  the  pigmentation  of  the  skin  of  this  part  serves  as 
an  aid  in  the  clinical  diagnosis  of  the  venereal  diseases  of 
horses,  in  which  important  discolorations  occur. 

The  muscles  of  the  vulva,  which  are  chiefly  circular,  are 
divided  into  two  groups — the  posterior  and  anterior  con- 
strictors. The  posterior  constrictor,  situated  within  the 
vulvar  lips,  constitutes  a  true  sphincter,  analogous  to  those 


42  Diseases  of  the  Genital  Orgayis 

about  other  body  openings.  Above,  its  fibers  become  lost 
in  the  perineum  and  the  sphincter  ani ;  below,  some  go  to 
the  base  of  the  clitoris  and  some  pass  downward,  to  become 
lost  in  the  skin  and  other  tissues  of  the  thighs.  Their  con- 
traction brings  about  the  closure  of  the  vulvar  opening. 
The  anterior  group  of  muscle  fibers  invests  the  vulva  in  the 


Fig.  21.     Vulva  and  Vagina  of  Cow. 

/,   Meatus  urinarius  ;   2,  2,   mouths  of  Bartholin's  glauds.     The   arrows 
point  to  very  small  cystic  swellings  in  Gartner's  ducts. 

region  of  the  hymen,  just  anterior  to  the  meatus  urinarius, 
where,  by  their  contraction,  they  produce  a  constriction  on 
the  vulvo-vaginal  border  line. 

Through  the  medium  of  the  surrounding  aponeuroses,  the 
vulvar  muscles  acquire  continuity  with  the  ischium,  sacrum. 


The  Vulva  43 

and  postero-superior  border  of  the  sacro-sciatic  ligament, 
thus  affording  the  vulva  a  secure  attachment  to  the  posterior 
opening  of  the  pelvis  and  furnishing  a  fixed  base  upon  which 
the  entire  genital  canal  may  act  in  parturition.  This  fixa- 
tion enables  the  uterus,  when  contracting,  to  force  the  fetus 
back  toward  and  through  the  cervical  canal,  the  vagina,  and 
the  vulva.  It  is  this  fixed  base  of  attachment  which  enables 
the  contracting  uterus  at  the  time  of  parturition  to  dilate 
and  virtually  efface  the  cervical  canal,  obliterating  all  its 
mucous  folds  and  increasing  its  calibre  sufficiently  to  afford 
room  for  the  passage  of  the  fetus. 

The  vulvar  mucous  membrane,  continuous  with  that  of 
the  urinary  bladder  and  the  vagina,  is  covered  with  squam- 
ous epithelium  and  contains  numerous  mucous  glands, 
which  are  largely  displaced  near  the  labial  margins  and 
about  the  clitoris  by  sebaceous  follicles,  the  secretions  from 
which  are  odoriferous,  especially  during  estrual  periods, 
when  the  odor  becomes  very  marked  in  a  manner  charac- 
teristic of  the  species. 

Within  the  vulvar  cavity  are  to  be  noted  the  meatus  urin- 
arius,  clitoris,  Bartholin's  glands,  and  vaginal  bulb.  In  the 
mare  the  meatus  urinarius,  or  terminal  opening  of  the 
urethra,  is  located  along  the  floor  of  the  vulva  at  a  distance 
of  three  to  four  inches  from  the  external  opening.  The 
urethral  canal  passes  obliquely  downward  and  forward 
through  the  vaginal  floor  to  the  urinary  bladder.  In  most 
animals  the  meatus  urinarius  is  comparatively  small  and  in- 
extensible.  In  the  mare  it  is  large  and  freely  dilatable. 
With  patience,  one,  two  or  more  fingers  may  be  pressed 
gradually  through  it  into  the  bladder,  and  it  is  not  rare  to 
find  the  opening,  in  heavy,  coarse  animals,  sufficiently  large 
to  admit  without  great  difficulty  the  entire  hand.  The  am- 
plitude of  the  meatus  urinarius  in  the  mare  is  of  special 
significance  clinically,  as  it  favors  eversion  and  prolapse  of 
the  bladder,  an  accident  not  particularly  rare  in  this  ani- 
mal, though  extremely  so  in  others.  In  the  cow  the  narrow 
meatus  urinarius  has  beneath  its  vulvar  opening  a  small 
sac,  or  infundibulum.       The  supero-anterior  wall  of  the 


44 


Diseases  of  the  Genital  Organs 


sinus  constitutes  the  inferior  terminal  wall  of  the  ureter 
causing  it  to  act  essentially  as  a  valve,  rendering  cathe- 
terization difficult. 

Bartholin's  glands,  (See  Figs.  18,  21)  like  Gartner's 
ducts,  are  vestigial  structures  presumed  to  represent  the 
bulbo-urethral,  or  Cowper's  glands,  of  the  male.  In  the 
cow  they  consist  of  small,  glandular  structures  located  be- 
hind the  vulvo-vaginal  or  hymeneal  border,  about  midway 
from  floor  to  roof  of  the  copulatory  canal,  backward,  up- 
ward and  outward  from  the  meatus  urinarius.  Their  in- 
terest lies  largely  in  the  fact  that,  like  Gartner's  ducts,  their 
mouths  become  occluded  as  a  result  of  infection  causing, 
in  the  cow  especially,  retention  cysts  in  the  vaginal  walls. 

The  clitoris  is  composed  chiefly  of  erectile  tissue  like  that 
of  the  corpus  cavernosum  of  the  penis.  The  clitoris  of  the 
bitch,  like  the  penis  of  the  dog,  contains  a  small  bone.  The 
functions  of  the  clitoris  are  not  important,  although  it  is 
alleged  to  exert  an  influence  upon  sexual  excitement.  In 
observations  upon  a  large  number  of  sows  from  which 
the  clitoris  had  been  removed  by  an  empiric,  the  operation 
had  no  influence  upon  estrum  or  fecundation  and  all  bred 
normally. 

C.     The  Physiology  of  the  Genitalia 

The  specific  function  of  the  generative  organs  is  the  pro- 
creation of  the  species,  including  conception,  the  intra- 
uterine nutrition  and  development  of  the  fetus,  and  its  ex- 
pulsion after  a  certain  degree  of  development.  As  the  two 
sexes  in  mammalia  are  wholly  distinct,  before  conception 
can  take  place  a  conjunction  of  the  male  and  female — 
coition,  or  copulation  —  must  occur.  In  each  individual 
there  are  more  or  less  apparent  vestiges  of  each  part  of  the 
genital  apparatus  of  the  opposite  sex,  but  these  naturally 
become  arrested  in  their  development  in  the  embryonic 
stage  and  remain  wholly  functionless. 

Before  reproduction  becomes  possible,  the  breeding  ani- 
mal must  have  reached  the  period  of  puberty,  or  sexual 
maturity,  which  is  marked  by  the  advent  of  sexual  desire. 
When  this  period  has  been  reached,  ova  mature  in  the  ovary 


The  Viilva  45 

of  the  female  and  spermatozoa  in  the  testicle  of  the  male. 
Up  to  this  time,  the  reproductive  organs  are  dormant  in  so 
far  as  their  specific  functions  are  concerned.  Puberty,  or 
sexual  maturity,  occurs  at  varying  ages  in  different  species, 
breeds,  and  individuals,  depending  upon  the  food  supply 
and  rapidity  of  growth.  It  occurs  quite  uniformly  in  both 
sexes  prior  to  the  completion  of  growth. 

Reproduction  is  a  complex  physiologic  process,  accom- 
panied by  or  associated  with  phenomena  which  bear  an  im- 
portant relation  to  each  other.  In  approximately  the  fol- 
lowing order,  there  are  observed  the  maturation  of  the 
ovisac — or  Graafian  follicle — estrum,  copulation,  rupture  of 
the  ovisac,  fecundation,  and  possibly  menstruation.  The 
chain  of  phenomena  is  finally  completed  by  pregnancy,  par- 
turition, and  the  nutrition  of  the  new-born. 

The  ovaries  consist  at  first  of  a  mere  thickening  of  the 
peritoneum,  due  to  an  elaboration  of  its  epithelial  cells.  The 
external  cell  layer  becomes  columnar.  The  cells  of  the 
deeper  strata  assume  a  more  or  less  cuboidal  form,  to  can- 
stitute  the  germinal  cells,  and  certain  of  their  number  be- 
come distinctly  larger  than  the  others,  to  form  the  primitive 
ova.  The  deeper  epithelial  layers  are  broken  into  irregular 
columnar  masses,  or  egg  columns,  through  the  growth 
among  them  from  below  of  blood  vessels  and  connective 
tissue.  Prior  to  birth,  in  those  young  which  are  born  in  a 
well  developed  state,  and  shortly  after  birth  in  the  imma- 
ture young  like  that  of  the  rabbit,  some  of  the  primitive 
ova  become  materially  changed,  to  constitute  permmient 
ova.  In  the  cell  masses  the  vermayient  ova,  developed  from 
the  primitive  ova,  become  much  larger  than  the  others, 
while  the  nucleus,  or  germinal  vesicle  enlarges  and  its  en- 
veloping membrane  becomes  distinct.  The  contents  of  the 
nucleus  become  massed  at  one  point  and  form  a  distinct 
reticulum,  in  which  one  or  more  nodal  points  enlarge  to 
constitute  the  nucleolus,  or  germinal  spot.  The  neighbor- 
ing germinal  cells  become  arranged  about  the  ovum  in  such 
a  manner  as  to  enclose  it  completely  in  a  follicle,  which  has 
at  first  a  single  layer  of  cells.     Later  a  second  layer  of  cells 


46  Diseases  of  the  Genital  Organs 

forms  within  the  first,  closely  investing  the  ovum  and  con- 
tinuous at  one  point  v^ith  the  cellular  layer  of  the  wall. 
This  mass  of  cells,  bearing  within  it  the  permanent  ovum, 
constitutes  the  discus  proligerus. 

The  cells  of  the  follicular  walls  multiply  rapidly.  The 
external  enveloping  layer  extends  more  rapidly  than  the 
inner  discus  proligerus  causing  a  separation  between  the 
two,  except  at  the  point  of  attachment  of  the  latter.  A  sec- 
tion through  the  discus  proligerus  and  follicle  reveals  a 
crescent-shaped  cavity  filled  with  fluid.  Fully  developed, 
this  constitutes  the  ovisac,  or  Graafian  follicle,  which  con- 
sists of  the  outer  layer  of  follicular  cells,  or  tunica 
granulosa,  and  the  inner  granular  cells,  the  discus  proli- 
gerus, embedded  within  which  lies  the  ovum.  The  cavity 
of  the  follicle  between  the  two  masses  of  cells  is  occupied  by 
the  follicular  fluid.  The  immature  egg  sac  usually  lies 
deep  within  the  ovary.  As  it  matures  and  the  volume  of 
follicular  fluid  increases,  it  approaches  the  surface  of  the 
ovary.  In  the  cow  about  one-half  of  the  ovisac  protrudes 
finally  beyond  the  general  ovarian  surface  as  a  hemisphere, 
^  hile  the  other  half  remains  below  the  general  level  of  the 
gland.  The  ripe  ovisac  of  the  cow  is  about  one-half  to  five- 
eighths  of  an  inch  in  diameter.  In  the  sow  the  ovisac  grows 
completely  beyond  the  ovarian  surface  and  appears  as  a 
pedunculated  cyst  one-fourth  inch  in  diameter.  In  push- 
ing toward  and  beyond  the  ovarian  surface,  the  tunica  al- 
buginea,  or  ovarian  capsule,  atrophies  and  disappears  at  the 
summit  of  the  distended  sac,  and  the  peritoneum  is  pushed 
outward.  The  follicular  wall  becomes  very  thin.  During 
rectal  palpation  in  the  cow,  the  ovisac  often  ruptures  under 
very  slight  pressure.  During  the  maturation  of  the  ovisac, 
the  ovum  undergoes  important  changes.  Before  the  ovisac 
ruptures,  the  nucleus  of  the  ovum  passes  from  the  center  of 
the  egg  toward  its  periphery;  a  definite  vitelline  membrane 
is  formed  within  the  Z07ia  radiata  immediately  about  the 
nucleus  of  the  ovum;  the  nucleus  becomes  indistinct;  and, 
while  the  yolk  retracts  slightly  from  the  vitelline  membrane 
at  one  point,  the  first  polar  body,  a  small  mass  apparently 
derived  from  an  unequal  division  of  the  nucleus,  is  assumed 
to  be  extruded. 


Estriivi 


47 


When  the  Q%<g  has  fully  ripened  and  the  ovisac  has  com- 
pleted its  growth  and  is  fully  distended  with  fluid,  estrum, 
or  "heat",  occurs. 

2.    Estrum 

Preliminary  to  reproduction,  an  irresistible  sexual  desire 
occurs,  leading  to  coition. 

Estrum  finds  expression  in  various  ways  in  different 
species  of  animals.  In  general  there  is  a  nervous  excitabil- 
ity, the  external  genitals  are  swollen  and  vascular,  and  there 
is  an  increased  secretion  of  mucus  from  the  vulva  and  the 

Germmal  EpitKeliurn 

Trim  ay  y  Follidc 


"» 

■^« 

"--^^ 

-  T' ' 

<'Z' 

'>  ' 

B 

Fig.  22 — Section  of  ovary  of  cow  showing  a  follicle, 
0.6  mm.,  with  ovum. 

vagina.  In  the  mare,  when  other  horses — especially  stal- 
lions— are  present,  there  are  frequent  emissions  of  urine  in 
small  quantities,  and  the  vulvar  lips  are  frequently  opened 
and  the  erected  clitoris  protruded.  In  the  cow^  and  the  sow, 
the  female  imitates  the  copulatory  act  of  the  male  by  mount- 


48  Diseases  of  the  Genital  Orga)is 

mg,  or  standing  to  be  mounted  by,  other  animals  of  its 
species.  The  ewe  ordinarily  shows  little  or  no  evidence  of 
estrum  except  in  the  presence  of  the  male.  In  certain 
pathologic  cases  (nymphomania)  the  cow  especially  does 
not  confine  her  expressions  of  sexual  desire  to  her  own 
kind,  but  may  attempt  to  mount  other  species  of  animals. 

In  all  animals  there  is  a  tendency  during  estrum  for  the 
female  to  wander  from  home.  This  is  most  noticeable  in 
the  bitch  and  the  cat,  which,  if  not  securely  confined,  disap- 
pear, tending  to  wander  long  distances  and  to  remain  away 
during  a  large  part  or  all  of  the  estrual  period.  The  sexual 
wanderings  of  domestic  animals  constitute  an  interesting 
chapter  in  the  dissemination  of  infectious  diseases. 


Fig.  23 — Section  of  ovary  of  cow  showing-  a  follicle  of 
2  mm.,  with  ovum. 

The  female  exhibits  sexual  desire  only  for  a  compara- 
tively brief  time,  during  the  existence  of  a  ripe  ovisac  or 
ovisacs  in  the  ovary.  The  duration  of  the  estrual  period 
varies  widely,  according  to  species.  It  is  shortest  in  the 
cow,  ranging  ordinarily  between  eighteen  and  twenty-four 
hours,  or  a  trifle  longer.  The  mare  is  usually  in  estrum  for 
several  days.  The  bitch  is  in  estrum  for  ten  to  fifteen  days. 
In  healthy  females,  the  estrual  cycle  is  quite  uniform.  In 
the  cow  it  is  twenty  to  twenty-two  days,  usually  twenty-one ; 
in  the  mare  3  to  4  weeks ;  in  the  bitch  ordinarily  every  six 
months.  The  frequency,  intensity,  and  duration  of  estrum 
are  profoundly  modified  by  the  state  of  nutrition,  diseases 
of  the  genital  organs,  and  by  serious  systemic  diseases. 


Ovidatio7i  49 

3.    Ovulation 

At  about  the  close  of  estrum,  in  those  animals  where  the 
phenomena  have  been  studied,  as  in  the  cow,  the  distended 
ovisac  ruptures  and  discharges  the  ovum.  Prior  to  the  rup- 
ture of  the  ovisac,  preparation  for  the  detachment  of  the 
ovum  from  the  enveloping  and  supporting  cells  of  the  dis- 
cus proligerus  has  been  made  by  the  formation  of  numerous 
vacuoles  in  the  mound,  as  shown  in  Fig.  24.  The  attachment 
of  the  ovum  is  rendered  exceedingly  frail,  subject  to  de- 
tachment upon  the  slightest  disturbance.  The  ovum  is  ap- 
parently maintained  in  situ  chiefly,  if  not  wholly,  by  the 


C<'i'OTia  vadiaXa 


FiG.  24— Section  of  ovary  of  cow  with  a  nearly  ripe  ovum  in 

an  ovisac,  5x7  mm.,  showing  vacuoles  in  the 

cumulus  preparatory  to  ovulation. 

sustaining  pressure  of  the  follicular  liquid.  When  the  ovi- 
sac ruptures,  the  ovum,  the  follicular  fluid,  and  some  of  the 
granular  cells  of  the  discus  proligerus  in  \.hich  the  ovum 
was  embedded  are  discharged  into  the  pavilion  of  the  ovi- 
duct, which  is  at  this  epoch  erected  and  closely  applied  to 
the  ovary  at  that  point  where  the  ovisac  is  about  to  rupture. 
Here,  if  successful  copulation  has  occurred,  spermatozoa  are 
already  present,  meet  the  ovum  and  a  single  spermatozoon 
fuses  with  each,  to  constitute  fertilization. 

The  precise  period  at  which  ovulation  occurs,  as  related 
to  estrum,  has  not  been  determined  for  all  domestic  animals. 
In  the  rabbit,  which  has  given  birth  to  young,  copulation 


50 


Diseases  of  the  Genital  Organs 


occurs  immediately  following  parturition.  Ovulation  fol- 
lows about  twelve  hours  later — an  interval  sufficiently  great 
for  the  migration  of  spermatozoa  from  the  vagina  to  the 
ovary.  In  the  cow,  estrum  persists  ordinarily  for  but  twelve 
to  twenty-four  hours,  and  ovulation  occurs  at  about  the 
close  of  this  period.  If  copulation  occurs  early  in  estrum, 
better  opportunity  is  afforded  for  the  arrival  of  spermatozoa 
at  the  pavilion  of  the  oviduct  prior  to  the  rupture  of  the 
ovisac  and  discharge  of  the  ovum.  In  swine,  carnivora,  and 
to  some  degree  in  solipeds,  the  estrual  period  is  prolonged, 
extending  over  several  days.  In  these  there  are  no  accurate 
data  of  the  epoch  of  ovulation.  Probably  ovulation  occurs 
at  a  time  corresponding  to  that  observed  in  the  cow — that  is, 
at  about  the  close  of  estrum. 


Fig.  25— Diagram  of  ovary  of  cow  showing  comparative 
sizes  of  the  follicles  shown  in  Figs.  22,  2a,  24 

The  number  of  ovisacs  rupturing  at  a  given  estrual  period 
corresponds  as  a  rule  with  the  maximum  number  of  possible 
fetuses.  It  is  said  that  rarely  two  ova  are  contained  in  one 
ovisac.  I  have  been  unable  to  verify  this  statement,  and 
have  in  all  cases  of  twins  in  the  cow  observed  two  corpora 
lutea,  sometimes  both  in  one  ovary  but  most  frequently  one 
in  each.  Sometimes  a  single  fertilized  ovum  divides  to  con- 
stitute two  embryos,  which  form  identical  twins  in  man, 
but  this  is  not  known  to  occur  in  domestic  animals,  though 
it  probably  does  so.  In  multipara,  it  is  assumed  that  there 
are  at  least  as  many  ova  discharged,  from  as  many  ovisacs, 
as  there  are  embryos. 


Ovulation 


51 


Physiologically,  estrum  and  ovulation  are  inhibited  by 
pregnancy ;  abnormally,  they  occur  while  the  animal  is  preg- 
nant and  the  fetus  alive  and  well. 

4.    Menstruation 

If  a  heifer  or  a  cow  fails  to  conceive,  when  estrum,  copu- 
lation, and  ovulation  have  occurred,  or  if  copulation  has 
failed,  she  regularly  menstruates.  If  she  conceives,  she 
does  not  as  a  rule  menstruate.  Evidently  the  engorgement 
of  the  uterus  during  estrum  is  designed  to  fit  the  genital 
tract  for  the  protection  and  nutrition  of  the  fertilized  ovum. 
Should  fertilization  fail,  capillary  hemorrhage  from  the 
placental  areas  follows.  The  volume  of  hemorrhage  is  suf- 
ficient that  the  blood  is  expelled  through  the  vagina  and 
vulva  to  stain  the  exterior  vulvar  region  and  adjacent  parts. 
Upon  the  killing  floor  of  the  abattoir,  heifers  or  cows  having 
in  their  ovaries  ripe  ovisacs  have  engorged  uteri  with  special 
engorgement  of  the  placental  areas.  If  the  ripe  ovisac  has 
ruptured,  and  presumably  fertilization  has  failed,  the  pla- 
cental areas  are  covered  over  with  thin  coagula  of  bright 
red  blood.  Later  this  is  expelled,  to  constitute  the  menstrual 
fluid.  The  exact  significance  of  menstruation  is  not  fully 
determined.  By  my  observations  I  have  been  led  to  the  con- 
clusion that  menstruation  constitutes  reliable  evidence  of  a 
failure  to  conceive,  so  far  as  the  estrum  just  past  is  con- 
cerned.   Apparently  there  are  exceptions  to  the  rule. 

There  is  much  controversy  amongst  embryologists  and 
human  obstetrists  regarding  the  relationship  between  men- 
struation, ovulation,  and  conception.  There  is  no  outstand- 
ing estrual  period  in  woman,  and  scant  opportunity  for  the 
clinical  study  of  ovulation.  The  cow  offers  the  best  available 
animal  for  such  study.  Her  estrual  period  is  sharp,  clear, 
and  brief;  the  ovary  is  conveniently  palpated  per  rectum; 
the  ripe  ovisac  is  clearly  recognizable  by  palpation ;  and  the 
crater  of  the  recently  ruptured  sac  is  clearly  palpable.  The 
order  of  the  phenomena  is  clearly  and  indisputably — 
maturation  of  the  ovisac,  estrum  (with  copulation,  if  oppor- 
tunity exists),  ovulation,  and  fertilization,  or,  if  fertilization 


52  Diseases  of  the  Genital  Organs 

fails,  menstruation.    The  cow  is  probably  representative  for 
mammalia  in  general. 

5.    The  Corpus  Luteum  of  Estrum 

Ovulation  leaves  behind  a  crater  having  the  same  diame- 
ter as  the  ovisac  which  ruptured.  Into  this  crater,  physio- 
logically, a  small  amount  of  blood  escapes  at  once  and  quickly 
clots.  The  walls  of  the  crater  rapidly  approach  each  other 
and  within  a  few  hours  there  remains  a  small,  deep  cavity, 
about  one-eighth  to  three-sixteenths  of  an  inch,  filled  with  a 
blood  clot.  Ovulation  has  necessarily  caused  a  lesion,  com- 
parable in  some  respects  to  a  wound,  in  which  ordinarily  the 
wound  cavity  is  to  a  greater  or  less  extent  filled  with  coagu- 
lated blood,  and  like  the  wound  in  the  body  covering,  the 
lesion  offers  an  open  avenue  for  invasion  by  any  bacteria 
existing  in  the  peritoneal  cavity  or  within  the  oviduct.  Such 
infection  frequently  interrupts  the  orderly  physiologic  pro- 
cesses and  leads  to  a  variety  of  pathologic  lesions. 

Soon  after  the  rupture  of  the  ovisac  and  discharge  of  the 
ovum,  there  is  elaborated  from  the  walls  of  the  crater  a 
distinctive  tissue  designated  the  corpus  luteum  (yellow 
body)  because  its  prevailing  color  in  pregnant  animals  is 
yellow.  The  corpus  luteum  consists  of  a  network 
of  capillaries,  some  connective  tissue,  and  essentially  of 
special  lutein  cells  emanating  from  the  membrana  granu- 
losa and  theca  interna  of  the  ovisac.  The  method  of  gro\\i;h 
causes  the  corpus  luteum  to  repeat  at  first  the  form  of  the 
crater  from  the  sides  of  which  it  originates.  Originally  it 
is  a  cup-shaped  structure  opening  upon  the  surface  and 
filled  in  its  center  by  the  small  blood  coagulum  which  formed 
in  the  crater  of  the  ruptured  ovisac  immediately  after  ovu- 
lation. The  corpus  luteum  pushes  its  way  out  somewhat 
through  the  rupture  in  the  ovarian  tunic  and  projects  (in 
the  cow)  somewhat  above  the  ovarian  surface  as  a  cylin- 
drical or  conical  mass  of  granulations,  one-eighth  to  one- 
half  inch  in  diameter.  The  cavity  in  the  center  of  the  cor- 
pus luteum  of  the  cow  is  gradually  eliminated  by  the  growth 
of  the  lutein  tissue  and  at  the  same  time  the  epithelium  of 


The  Corptis  Ltiteum  of  Estrtun  53 

the  ovary  draws  over  the  naked  granulating  surface  until 
at  seven  to  ten  days,  the  structure,  if  physiologic,  has  lost 
its  central  cavity,  the  blood  coagulum  has  disappeared  and 
the  epithelium  of  the  ovary  has  recovered  its  continuity. 
The  corpus  luteum  of  the  cow  is  then  five-eighths  to  three- 
quarters  of  an  inch  in  diameter,  usually  spherical  or  ovoid, 
but  subject  to  numerous  variations,  has  an  even  contour 
and  is  firm  in  consistence.  It  is  readily  recognized  in  the 
cow  by  rectal  palpation  and  usually  easily  dislodged  by  digi- 
tal compression.  If  the  ovum  discharged  is  not  fertilized, 
or  if  the  fertilized  ovum  perishes  quickly,  the  corpus  luteum 
of  the  cow  is  not  yellow  but  with  great  uniformity  is  choco- 
late or  liver-colored.  Its  size,  contour,  and  consistence  are 
essentially  the  same  as  in  pregnancy.  The  volume  remains 
virtually  constant  after  its  growth  has  been  completed  at 
seven  to  ten  days  until  at  a  period  of  about  three  or  four 
days  prior  to  the  maturation  of  the  next  ovisac,  when  it 
commences  to  atrophy  rapidly,  and  when  about  one-fourth 
inch  in  diameter,  a  new  ovisac  ripens,  generally  in  the  oppo- 
site ovary,  the  animal  is  again  in  estrum  and  ovulates.  The 
old  yellow  body  has  permanently  ceased,  so  far  as  known, 
to  exert  any  influence  upon  the  reproductive  processes.  It 
continues  to  atrophy  slowly.  There  are  frequently  visible 
in  a  single  section  in  the  ovary  of  the  cow,  three  to  five  old 
corpora  lutea,  one-eighth  inch  or  less  in  diameter,  with 
white  strands  of  connective  tissue  scattered  amongst  the 
nests  of  lemon  or  orange-colored  lutein  cells. 

6.    Copulation 

The  male  ordinarily  exhibits  little  or  no  sexual  desire  ex- 
cept in  the  presence  of  a  female  in  estrum,  but  the  testes 
function  constantly.  The  sexual  desire  may  be  activated 
at  any  time  when  a  female  in  estrum  approaches  sufficiently 
near  to  be  recognized,  and  copulation  occurs  when  opportu- 
nity offers. 

During  the  act  of  copulation,  the  semen  from  the  male  is 
ejaculated  into  the  vagina  of  the  female,  possibly  in  part 
into  the  cervical  canal.    The  semen  has  as  its  essential  con- 


54  Diseases  of  the  Genital  Organs 

stituent  the  spermatozoa,  or  sperm  cells,  elaborated  by  the 
testicles.  Prior  to  copulation  the  spermatozoa  lie  chiefly  in 
the  epididymis  and  vas  deferens,  being  exceedingly  concen- 
trated in  these  tubules.  At  the  moment  of  ejaculation, 
there  is  thrown  into  the  pelvic  urethra  the  liquid  secretions 
from  the  vesiculae  seminales,  prostate  and  Cowper's  glands 
which  serve  to  dilute  greatly  the  very  dense  mass  of  sper- 
matozoa and  facilitate  the  forcible  ejaculation  of  the  semen. 
Chief  amongst  these  glands  in  the  bull,  are  the  seminal  vesi- 
cles. If  these  are  removed,  or  are  so  diseased  that  their 
function  is  impaired  or  in  abeyance,  the  bull  copulates  with 
difficulty  apparently  owing  to  the  absence  of  the  diluent 
fluid  from  these  structures.  Some  think  that  most  or  all  of 
the  semen  is  ejaculated  directly  through  the  cervical  canal 
into  the  body  of, the  uterus  and  that  the  urethral  opening  of 
the  male  comes  in  direct  contact  with  or  enters  the  os  uteri. 
Harms,  quoting  Duranton  (Journal  de  Lyon,  1888),  cites  a 
case  of  alleged  rupture  in  the  uterine  cornu  of  a  cow  during 
copulation,  owing  to  the  entrance  of  the  penis  of  the  bull 
through  the  cervical  canal,  but  this  must  have  been  an  error 
in  clinical  history.  A  study  of  the  cervical  canal  of  the  cow, 
as  delineated  in  figures  15,  16,  17,  suffices  to  refute  any  alle- 
gation of  the  entrance  of  the  penis  into  it.  It  is  an  anatomi- 
cal impossibility.  In  the  mare,  with  a  far  more  dilatable 
cervical  canal,  copulatory  injuries  from  an  unusually  long 
penis  occur  in  the  vagina — not  in  the  uterus.  Male  animals, 
after  the  amputation  of  a  considerable  portion  of  the  penis, 
are  quite  as  fertile  as  before,  although  the  stump  of  the  or- 
gan can  not  reach  the  os  uteri.  Clinically,  a  large  part  of  the 
semen  is  ejected  from  the  vulva  of  the  female  immediately 
after  copulation,  and  quantities  of  semen  are  readily  ob- 
tained from  the  vagina  at  this  time. 

The  condition  essential  to  fecundation,  so  far  as  the  male 
is  concerned,  is  that  physiologically  perfect  spermatozoa 
shall  gain  the  cervical  canal,  traverse  the  uterus  and  ovi- 
ducts, and  meet  the  ovum  in  the  pavilion  of  the  oviduct.  Of 
the  countless  myriads  of  sperm  cells  in  one  discharge  of 
semen,  but  one  can  take  part  in  the  fertilization  of  the  ovum. 

The  migration  of  the  spermatozoa  from  the  vagina  to  the 


Fertilization 


55 


pavilion  of  the  oviduct  involves  a  period  of  brief  duration, 
probably  varying  in  different  species,  Marshall  estimates 
that  in  the  rabbit,  the  migration  of  the  spermatozoa  requires 
but  fifteen  minutes  to  two  hours.  Copulation  occurs  eight 
or  more  hours  prior  to  ovulation  so  that  the  spermatozoa 
ordinarily  arrive  at  the  pavilion  of  the  tube  six  or  more 
hours  prior  to  ovulation  and  lie  in  wait  preparatory  to  im- 
mediate fertilization.  According  to  clinical  observations  in 
cows,  ovulation  occurs  at  approximately  eight  to  twelve 
hours  after  the  cessation  of  estrum.  Ovulation  is  apparently 
hastened  (and  estrum  abbreviated)  by  copulation.  The  in- 
fluence of  copulation  upon  ovulation  in  higher  animals  ap- 
pears somewhat  analogous  to  insemination  in  the  frog, 
where  the  sexual  embrace  of  the  male  apparently  favors  the 
ovulation.  It  appears  from  available  data  that  the  sper- 
matozoa of  the  bull  traverse  the  twenty  to  twenty-five  or 
more  inches  of  the  genital  tube  (cervix,  uterus,  and  ovi- 
ducts) in  two  or  three  hours  and  are  present  in  the  pavilion 
of  the  oviduct  some  time  prior  to  ovulation.  In  this  manner 
the  single  ovum  meets  at  once  many  spermatozoa  so  that 
its  prompt  fertilization  is  luxuriantly  provided  for. 

9.  Fertilization 

Fertilization,  fecundation,  or  conception  follows  when  a 
healthy  female  copulates  naturally  with  a  healthy  male. 
Since  copulation,  in  those  animals  in  which  the  sequence  is 
known,  precedes  ovulation,  spermatozoa  have  already  mi- 
grated through  the  genital  tube  and  have  reached  the  pa- 
vilion of  the  oviduct,  where  they  await  the  discharge  of  the 
ovum.  One  spermatozoon  penetrates  each  q^%  and  traverses 
the  zona  radiata  to  the  nucleus.  The  nucleus  of  the  sper- 
matozoon fuses  with  that  of  the  ovum.  A  beginning  has 
been  made  for  the  development  of  a  new  individual.  The 
animal  has  conceived. 

10.    The  Migration  of  the  Fertilized  Ovum 

After  the  ovum  has  been  fertilized  in  the  pavilion  of  the 
oviduct,  it  must  traverse  the  length  of  the  tube,  reach  a 


56  Diseases  of  the  Genital  Organs 

suitable  location  in  the  uterus,  and  become  implanted  there 
before  it  can  advantageously  receive  ample  nutriment  for 
needed  growth  and  development.  The  migration  through 
the  oviduct  must  occur  with  sufficient  celerity  that  the  ovum 
shall  enter  the  uterine  cavity  prior  to  any  noteworthy 
growth  in  volume  for  the  reason  that  the  lumen  of  the  tube 
is  so  small  that  important  increase  in  the  size  of  the  ^zz 
would  imperil  its  passage.  It  is  probably  owing  to  patho- 
logic decrease  in  its  lumen  that  the  ovum  occasionally 
lodges  in  the  oviduct  of  woman  (tubal  pregnancy),  de- 
stroying the  life  of  the  embryo  and  greatly  imperilling 
the  life  of  the  mother.  The  migration  of  the  ovum, 
unlike  that  of  the  spermatozoa,  is  passive  and  is  brought 
about  by  the  action  of  the  cilia  of  the  tubal  epithelium  which 
wave  toward  the  uterus,  and  probably  by  muscular  action 
in  the  walls  of  the  oviduct.  The  time  required  in  domestic 
animals  is  not  known  but  in  the  cow  it  is  probably  eight  to 
fifteen  days. 

11.    The  Corpus  Luteum  of  Pregnancy 

The  formation  of  the  corpus  luteum  of  pregnancy  is  fun- 
damentally like  that  of  estrum  as  described  above.  Its 
source  of  origin,  its  method  of  growth  and  its  ultimate  vol- 
ume is  the  same.  It  presents  two  notable  characters  which 
serve  to  distinguish  it. 

The  color  of  the  corpus  luteum  of  pregnancy  in  the  cow 
is  regularly  of  a  bright  lemon  color,  in  contrast  with  the 
chestnut  or  muscle-colored  structure  of  estrum.  The  color 
distinction  is  not  universally  present.  Amongst  approxi- 
mately 2000  pregnant  cows  and  heifers,  I  have  observed  two 
corpora  nigra,  or  black  bodies,  one  normal  in  size,  the  other 
about  double  the  normal  volume.  The  rule  of  chestnut  color 
for  the  corpus  luteum  of  estrum  and  lemon  or  orange  color 
for  the  corpus  luteum  of  pregnancy  appears  at  times  to  be 
reversed.  Some  have  claimed  that  the  corpus  luteum  of 
estrum  is  often  lemon  or  orange-colored  but  I  believe  most 
of  these  reports  are  referable  to  error.  That  is,  observers 
not  familiar  with  their  ground  see  in  the  abattoir  an  empty 


The  Corpus  Ljiteiim  of  Pregnancy 


57 


^   ^  j 


0)    cfl  O 

S  y  <" 

M    ^  "^ 

O  t/)  ^ 

O  o  O 

a)  tn  in 

r^'S  IH 

I  -a  ^ 


53  Diseases  of  the  Genital  Organs 

uterus  and  an  orange-colored  corpus  luteum  and  consider 
the  structure  that  of  estrum.  But  there  has  been  pregnancy 
and  the  corpus  luteum  has  not  yet  disappeared. 

The  duration,  or  life,  of  the  corpus  luteum  of  pregnancy 
presents  a  strong  contrast  in  most  domestic  animals  to  the 
corpus  luteum  of  estrum.  The  corpus  luteum  of  pregnancy 
has  as  its  minimum  physiologic  life  the  duration  of  preg- 
nancy. The  simplest  cycle  in  ovulation,  pregnancy,  and 
atrophy  of  the  corpus  luteum  is  in  the  rabbit  where  the  dura- 
tion of  the  corpus  luteum  and  of  pregnancy  are  identical. 
The  doe  conceives,  the  corpus  luteum  forms,  in  four  weeks 
she  gives  birth  to  young,  the  corpora  lutea  have  atrophied, 
new  ovisacs  have  matured  and  immediately  after  parturi- 
tion she  copulates  with  the  male  and  conceives. 

In  the  cow,  the  corpus  luteum  forms  promptly  after  con- 
ception, attains  its  growth  in  seven  to  ten  days  and  physio- 
logically remains  static  until  thirty  to  ninety  days  post  par- 
tum,  or  for  a  period  of  ten  to  twelve  calendar  months. 
Pathologically  (retained  corpus  luteum,  pyometra,  macer- 
ated or  desiccated  fetus,  etc.),  the  corpus  luteum  of  preg- 
nancy may  remain  static  indefinitely  and  inhibit  estrum  and 
ovulation.  In  the  mare  it  appears  that  the  corpus  luteum 
of  pregnancy  atrophies  promptly  after  parturition  so  that 
she  is  ordinarily  in  estrum  at  seven  to  nine  days  post  par- 
tum,  thus  giving  it  a  physiologic  duration  of  about  three 
hundred  fifty-five  days.  In  those  animals  which  have  short 
periods  of  pregnancy  and  are  normally  in  estrum  semi-an- 
nually, like  the  bitch,  the  corpus  luteum  appears  to  persist 
for  a  comparatively  long  period  after  parturition  or  estrum. 

12.    The  Fetal  Membranes 

After  fertilization  has  occurred,  the  ovum  passes  through 
the  oviduct,  propelled  largely  by  the  cilia  of  the  tubal  epi- 
thelium, and  soon  reaches  the  uterine  cavity.  During  its 
tubal  migration,  the  ovum  has  undergone  segmentation. 
The  stored  food  material  in  the  ovum  is  insignificant,  so 
that  it  must  be  dependent  upon  the  uterus  for  any  nutrient 
material  for  the  maintenance  of  life  and  development.  The 
nutrition  of  the  ovum,  embryo,  and  fetus  is  throughout  in- 


The  Fetal  Me^nbranes 


59 


6o 


Diseases  of  the  Genital  Orf^ans 


direct:  that  is,  when  the  ovum  is  discharged  from  the  ovi- 
sac, its  direct  connection  with  the  tissues  of  the  mother  is 
finally  and  permanently  severed.  The  fertilized  ovum  at 
first  lies  free  upon  the  uterine  mucosa  while  nutrient  fluids 
poured  out  by  the  endometrium  are  absorbed  by  the  ovum 
to  provide  for  its  development.     Thus  far,  the  life  of  the 


Fig.  28— Fetal  Cotyledon  of  Cow  showing  primary  and  adventitious 
Placentae.      Photograph. 


ovum  has  been  supremely  precarious,  relying  wholly  upon 
a  delicately  balanced  physiologic  state  of  the  oviduct  and 
uterus  and  their  contents.  It  has  no  known  inherited  power 
to  resist  the  attacks  of  any  bacteria  contained  within  the 
tubo-uterine  cavity  and  has  no  known  power  to  maintain  a 
given  location.  Clinical  observation  leads  readily  to  the  be- 
lief that  the  mortality  of  the  fertilized  ova  during  this  period 


The  Fetal  Membranes 


61 


is  the  greatest  occurring  at  any  epoch  in  life.  The  death  is 
unseen,  and  is  necessarily  designated  sterility.  The  newly 
created  individual  needs  greater  fixidity  in  its  place,  more 
accurate  protection  against  invasion,  and  especially  a  safe 
and  abundant  food  supply.  While  the  ovum  lies  free  in  the 
uterine  cavity,  any  liquid  nutriment  available  is  in  constant 
danger  of  being  contaminated  by  any  bacteria  or  other  dele- 
terious substances  present  in  the  uterus.     Such  toxic  sub- 


FiG.    29— Maternal   (bottoiiO   and    Fetal    (top)  Cotyledons   of  Cow 
partly  detached.     A  portion  of  the  uterine  wall  seen 
at  bottom  and  of  choriom  at  top. 

stances  constitute  a  menace  by  threatening  to  invade  the 
new  individual  mixed  with  nutritive  substances,  through  a 
common  portal,  the  external  layer  of  the  morula.  The  nu- 
trition needs  to  be  more  dependable,  abundant,  and  imme- 
diate, and  guarded  as  far  as  possible  against  contamination 
from  every  source.  The  uterine  seal  hermetically  closes  the 
cervical  canal  to  direct  invasion  from  the  vagina.  Since 
the  ovarian  end  of  the  genital  tube,  though  opening  into  the 


62 


Diseases  of  the  Genital  Oi^nns 


peritoneal  cavity,  is  very  narrow  and  the  peritoneal  cavity 
is  assumed  to  be  physiologically  sterile,  the  embryo  lying  in 
the  genital  tube  between  the  tubal  and  cervical  openings, 
once  the  uterine  seal  is  physiologically  formed,  enjoys  a  high 
degree  of  safety  in  these  directions.       Two  vital  dangers 


Fig.  30 — Same   as  Fig-.  29,  showing  a  different  type  of  Placental 
Crypts  with  thickened,  fibrous  partitions  possibly 
due  to  prior  disease 

remain.  There  is  constant  peril  to  the  embryo  from  bacte- 
ria, already  old  habitants  of  the  utero-cervical  cavity,  and 
there  is  a  further  threat  of  unknown  potentiality  from 
micro-organisms  floating  in  the  blood  of  the  mother,  which 
may  invade  the  uterus  from  the  blood  stream.     Thejie  dan- 


The  Fetal  Membranes  63 

gers  are  obviated  in  part  by  the  formation  of  the  placenta. 
The  placenta  consists  of  two  complementary  parts — one 
due  to  a  special  development  of  the  w^hole  or  certain  areas 
of  the  uterine  mucosa,  or  endometrium,  of  the  mother,  and 
the  other  to  an  analogous  development  from  the  chorion  of 
the  fetus.  The  embryo  or  embryos  early  become  arrested 
and  detained  for  the  rest  of  intra-uterine  life  in  a  definite 
and  comparatively  fixed  location.     In  unipara  the  rule  is 


Fig.  3 1— Chorionic  Placenta  of  Ewe. 

The  right  hand  figure  includes  a  portion  of  the  Chorion. 

that  the  embryo  becomes  located  partly  within  the  cavity 
of  the  uterine  body,  with  the  remainder  of  its  body  lying  in 
that  horn  of  the  uterus  from  the  corresponding  ovary  of 
which  the  ovum  was  derived.  Pathologically,  the  fetus  of  a 
soliped,  instead  of  growing  into  the  uterine  body,  may  ex- 
tend across  the  ovarian  end  of  the  uterine  body  cavity  into 
the  opposite  horn,  to  constitute  bicornual  pregnancy.  In 
multipara  the   embryos   become   halted   at   approximately 


^4  Diseases  of  the  Genital  Organs 

equidistant  points  in  the  cornu  corresponding  to  the  ovary 
from  which  the  ova  emanated.  If  but  one  embryo  is  pres- 
ent in  a  horn,  it  is  ordinarily  near  its  base,  and  very  rarely 
may  become,  as  in  the  mare,  bicornual.  When  near  full 
term,  the  fetuses  may  be  very  irregularly  located,  owing  to 
the  fact  that  one  or  several  of  them  has  perished  and  later 
has  been  absorbed. 


Fig.  32 — Left.     Uterine  Cotyledon  of  Ewe, 
from  which  Fetal  Cotyledon  has  been  renidved,  leavintj  a  cavity. 
Right.     Median  section  of  Maternal  and  Fetal  Cotyledon  of  Ewe, 

with  portion  of  Chorion  attached. 

At  the  point  where  a  fertilized  ovum  becomes  located 
within  the  uterus,  the  adjacent  uterine  walls  promptly  as- 
sume increased  functional  activity,  become  increased  in 
thickness,  and  show  heightened  vascularity.  The  vital 
changes  occur  in  the  endometrium,  and  particularly  in  the 
placental  areas.  In  ruminants  with  multiple  cotyledonal 
placentae,  the  placental  areas  are  already  visible  in  the 
uterus  of  the  female  fetus  as  definite  elevations  in  the  uterine 
mucosa.    When  the  existing  placental  areas  or  caruncles  of 


The  Fetal  McDibrancs 


65 


the  ruminant  have  been  destroyed  by  disease,  the  former 
non-placental  areas  develop  adventitious  placental  struc- 
tures, but  in  such  cases  want  their  multiple  cotyledonal 
character  and  take  on  the  simpler  structure  of  a  diffuse 
placenta. 

As  soon  as  the  embryo  begins  to  form,  its  enveloping 
membranes  commence  to  develop,  first  the  amnion,  followed 
closely  by  the  allantois.  The  external  allantoic  wall  fuses 
with  the  external  amniotic  layer    (false  amnnion)   to  con- 


FiG.  33 — Fetal  and  Maternal  Placenta  of  Cow. 

The  chorionic  or  fetal  placental  tufts  are  shown   above  and  to  the  left, 

projecting  downward,  and  to  the  right,  into  the  placental 

crypts  of  the  uterus.     X310  (Pomayer). 

stitute  the  chorion.  In  all  domestic  animals  the  amnion  and 
allantois  each  constitutes  a  sac  containing  considerable  vol- 
umes of  amniotic  and  allantoic  fluids  respectively.  In  uni- 
para,  the  allantoic  sac  normally  pushes  out  to  the  apices  of 
both  uterine  horns  and  to  the  os  uteri  internum,  thus  ac- 
quiring contact  with  the  uterine  mucosa  throughout.  In 
ruminants  and  swine,  however,  the  tips  of  the  allantoic  sac 
early  become  necrotic  in  varying  degree,  as  shown  in  Figs. 
35  and  36.  The  necrotic  portion  retracts  at  times  from  the 
apex  of  the  cornual  cavity,  leaving  the  lumen  filled  with  pus 
and  debris.  In  extreme  cases,  the  entire  non-gravid  horn  of 
the  allantois  of  the  cow  becomes  necrotic  as  shown  in  Plate 


66  Diseases  of  the  Genital  Organs 

III.  Sometimes,  also,  as  shown  in  Plate  II,  the  chorion  be- 
comes necrotic  where  it  passes  across  the  os  uteri  internum. 
The  common,  small  necrotic  tips,  shown  in  Figs.  35  and  36, 
are  designated  as  "normal"  by  embryologists  but  these  pass 
by  imperceptible  gradations  into  the  degree  of  necrosis 
shown  in  Plate  III  which  is  clearly  and  grossly  pathologic. 
The  allantoic  sac,  fully  distended  with  fluid,  fills  the  uterine 
cavity  in  such  a  manner  that  violent  movements  of  the 
mother  cannot  readily  cause  any  material  displacement  be- 
tween the  uterine  wall  and  the  chorion,  but  both  are  moved 


^|«  - 

__•>■ 

Fig.  34.     Same  as  Fig.  33.     x  900.     (Poniayer). 

as  a  unit,  obviating  largely  any  dragging  upon  the  placenta 
which  might  threaten  to  cause  injury  thereto.  The  fetus 
floats  within  the  amniotic  fluid  and  the  amniotic  sac,  in 
turn,  floats  within  the  allantoic  fluid.  In  solipeds,  swine 
and  carnivora,  the  amniotic  sac  floats  freely  within  the 
allantoic  fluid,  except  for  the  allantoic  segment  of  the  um- 
bilic  cord ;  in  ruminants,  the  dorsum  of  the  amniotic  sac  is 
intimately  fused  with  the  chorion,  obliterating  the  allantoic 
cavity  in  this  area.  The  fetuses  of  solipeds,  swine,  and 
carnivora  may  be  expelled  from  the  uterus  through  a  rent 
in  the  chorion,  with  the  more  or  less  intact  amnion  envel- 
oping them,  but  in  ruminants  the  adhesion  of  the  amnion 


Al 


(Tr 


i   I' 


f 


■V)l 


if 


/- 


VX-" 


Plate  II 

Fetal  Sac  of  Cow  at  About  ioo  Days 

A.  Amnion. 

Al.  AUantois. 

1.  Necrotic  tip  of  non-gravid  horn. 

2.  Necrotic  isthmus  between  gravid  and  non-gravid  horn. 


-t3    o    c«    u 


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The  Fetal  Membrartes  67 

to  the  allantois  detains  the  former  within  the  chorion,  leav- 
ing it  an  essential  part  of  the  afterbirth  which  may  only 
escape  with  the  chorion.  The  ruminant  is,  therefore,  born 
naked. 


Fig.  35— Necrotic  Tips  of  Fetal  Sac,  Cow. 
/,  /,  /,  Living  allantois  ;  2,  2,  2,  necrotic  tips  ;  j,  chorionic  placenta. 

The  fetal  placental  structures,  originating  as  outgrowths 
from  the  allantois-chorion,  consist  fundamentally  of  branch- 
ing, arborescent  capillary  tufts  continuous  with  the  great 
vascular  network  of  the  allantois.     Regardless  of  placental 


68 


Diseases  of  the  Genital  Orgajis. 


type,  the  fundamental  structure  is  essentially  the  same  in 
all  species.  In  the  cotyledonal  placentae  of  ruminants,  the 
tufts,  longer  and  far  more  elaborately  branched,  sink  cor- 
respondingly deeply  into  the  placental  crypts  of  the  endo- 
metrium. The  chorionic  tufts  have  in  detail  their  counter- 
part in  the  crypts  into  which  they  project.     The  ultimate 


Fig.  36 — Necrotic  Tips  of  Fetal  Sacs,  Swine. 

/,  la,  Necrotic  embryos  in  totally  necrosed  fetal  sacs  ;   2,  2,  normal 

embryos  within  amnion,  the  allantois  having  been  opened  ; 

7,    necrotic    tip    of   allantois. 

chorionic  tufts  consist  of  capillary  walls  with  a  single  epi- 
thelial layer,  while  the  corresponding  maternal  crypt  con- 
sists also  of  capillary  loops  with  a  single,  delicate,  epithelial 
layer.  The  fetal  and  maternal  capillaries  remain  perma- 
nently separate  and  the  two  delicate  epithelial  layers  perma- 
nently separate  the  maternal  from  the  fetal  blood.  All  nu- 
triment and  waste  products  exchanged  between  the  mother 
and  the  fetus  must  pass  through  these  two  epithelial  bar- 
riers, which  together  constitute  the  placental  filter.  Through 


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The  Fetal  Membranes  69 

this  filter,  so  long  as  it  is  healthy,  no  solids  or  other  visible 
substances  ordinarily  pass.  Bacteria  are  not  known  to  pass 
this  filter  while  it  is  healthy.  Researches  show  further  that 
rarely  or  never  do  the  hypothetical  antibodies  pass  this 
filter,  so  that  a  mother  may  be  highly  infected  with  a  given 
bacterium  and  her  blood  react  strongly  by  agglutination  or 
complement-fixation  to  such  organism,  but  the  blood  of  her 
new-born  fails  to  react.  The  contact  between  the  fetal  and 
the  maternal  epithelium  is  so  intimate,  that  no  infection  nor 
foreign  substance  may  readily  exist  between  them.  Hence 
in  the  placental  area,  so  long  as  the  structures  are  healthy, 
so  far  as  known,  infection  can  not  pass  from  the  mother  to 
the  fetus  through  the  placental  filter,  nor  can  infection  in- 
vade the  fetus  from  the  uterine  cavity  by  passing  between 
the  two  fetal  structures,  and  thence  gain  the  fetal  cir- 
culation, without  having  first  attacked  and  severely  dam- 
aged the  placental  structures  themselves. 

The  Utero-Chorionic  Space.  There  is,  however,  a 
more  vulnerable  area  through  which  bacterial  invasion  of 
the  embryonic  sac  may  occur.  There  are  about  one  hundred 
functioning  cotyledons  in  the  healthy  gravid  uterus  of  the 
cow.  Each  of  these  cotyledons,  in  the  slaughtered  animal 
(they  are  doubtless  much  thicker  in  the  living  animal  while 
they  are  distended  with  blood)  is  one  to  one  and  one-half 
inches  in  its  perpendicular  diameter  while  the  peduncle  of 
the  cotyledon  measures  an  inch  or  more,  thus  tending  to 
push  the  chorion  away  from  the  non-placental  endometrium 
for  a  distance  of  two  inches.  The  one  hundred  cotyledons 
with  their  stalks  serve  as  a  great  colonnade  producing  a 
vast  space  between  the  non-placental  areas  of  the  uterus  and 
chorion,  designated  the  utero-chorionic  space.  At  full  term 
of  pregnancy,  the  uterine  mucosa  offers  an  area  of  approxi- 
mately fifteen  square  feet.  In  this  space,  as  in  the  non- 
gravid  uterus,  bacteria  commonly  exist  and  need  only  to  in- 
vade successfully  the  thin  non-placental  chorion  and  adher- 
ent amnion  to  gain  the  amniotic  cavity  and  fluid.  With  the 
fluid,  the  fetus  swallows  any  bacteria  present.  But  the  bac- 
teria have  other  interesting  portals  of  entry,  the  importance 


yo  Diseases  of  the  Genital  Organs 

of  which  is  not  at  present  known.  At  the  apex  of  each 
cornu,  the  tip  of  the  chorion  is  necrotic  and  is  commonly  sur- 
rounded by  exudate  or  pus.  It  would  appear  that  such  an 
area  would  offer  but  little  resistance  to  invasion  and  once 
the  bacteria  have  reached  the  allantoic  fluid,  the  very  thin 
amnion  offers  scant  barrier. 

Placental  Hemorrhage.  At  the  cervical  end  of  the 
uterus  there  also  exist  conditions  which  apparently  favor 
invasion  of  the  fetal  sac.  Nearly  always  placental  hemor- 
rhages exist  at  the  os  uteri  internum  and  some  of  the  cotyle- 
dons have  separated.  In  this  manner  the  placental  areas, 
denuded  of  protective  epithelium,  and  with  important  vol- 
umes of  blood  resting  upon  their  surfaces,  offer  an  inviting 
field  for  invasion. 

Uterine  Sand.  Such  placental  hemorrhages  must  be 
of  very  frequent  occurrence.  It  would  be  supposed  that  such 
hemorrhage  would  be  resorbed  in  a  few  days  so  that  the 
regular  meeting  with  them  would  seem  to  indicate  that  they 
occur  almost  constantly.  The  frequency  of  these  is  further 
suggested  by  the  existence  in  the  utero-chorionic  space  in 
essentially  all  cows  in  advanced  pregnancy,  of  bodies  I  have 
designated  uterine  sand.  These  are  free,  spherical  bodies 
generally  about  one-sixteenth  inch,  translucent  and  amber- 
colored.  They  are  very  hard,  are  insoluble  in  water  and 
alcohol.  They  vary  greatly  in  numbers  and  volume.  By  de- 
taching the  fetal  membranes  from  the  uterus,  washing  both 
surfaces  in  a  vessel  of  water,  and  then  decanting  it  off, 
there  remains  behind  a  mass  of  uterine  sand  varying  from 
half  a  dram  to  one  ounce,  feeling  much  like  sand  when 
grasped  between  the  fingers.  Its  exact  character  and  origin 
are  unknown  but  it  appears  most  probably  due  to  disinte- 
gration of  red  blood  cells,  and  if  so,  indicates  frequent  and 
important  placental  hemorrhages. 

In  ruminants,  therefore,  with  the  immense  utero-chori- 
onic space,  the  inter-cotyledonal  area  of  the  chorion  offers 
the  avenue  of  least  resistance  to  the  invasion  of  the  fetus. 
In  the  soliped,  where  no  non-placental  area  exists,  any  vul- 
nerable field  must  be  created  by  the  invasion  of  the  placental 


The  Fetal  Membranes  71 

structures.  After  such  infection  has  destroyed  the  placental 
power  of  resistance,  it  is  free  to  invade  the  fetus. 

The  development  of  the  placentae  is  a  cumulative  process 
from  the  time  of  the  formation  of  the  fetal  envelopes  until 
the  pregnancy  terminates.  It  has  been  stated  that  as  par- 
turition approaches,  the  placenta  undergoes  fatty  degenera- 
tion in  preparation  for  dehiscence.  That  is  untrue.  The 
embryonic  sac  at  first  lies  free  in  the  uterine  or  cornual 
cavity  without  visible  placental  structures.  Gradually  the 
placental  structures  become  macroscopically  apparent  but 
the  embryonic  sac  can  still  be  lifted  out  of  the  opened  uterus 
without  resistance.  Gradually  the  chorionic  tufts  lengthen, 
become  more  branched,  and  sink  deeper  and  deeper  into  the 
maternal  crypts.  In  the  abattoir,  it  becomes  necessary,  in 
separating  the  placenta,  to  use  gradually  increasing  care 
and  force  as  the  duration  of  pregnancy  advances.  Early  in 
pregnancy  the  chorionic  tufts  of  the  cow  appear  very  much 
the  same  as  the  short,  simple  structures  of  the  soliped,  but 
they  gradually  become  more  complex  as  the  close  of  preg- 
nancy nears.  This  is  essential  to  fetal  development,  which 
gathers  in  force  and  rapidity  from  the  time  of  fertilization 
up  to  the  end  of  pregnancy. 

The  force  which  maintains  the  contact  between  the  fetal 
and  the  maternal  placenta  is  not  readily  defined.  It  might 
be  termed  physiologic  magnetism.  This  force  continues  so 
long  as  the  fetus  lives  and  the  umbilic  cord  is  intact.  When 
birth  occurs  and  the  navel  cord  ruptures,  the  magnetism 
ceases.  The  blood  in  the  fetal  placental  capillaries  escapes 
through  the  broken  umbilic  veins.  The  capillaries  in  the 
chorionic  tufts  collapse,  automatically  fall  away  from  the 
crypt  walls  and  drop  out.  Thus,  in  preparing  histologic 
sections  of  healthy  placental  structures  one  does  not  see  the 
chorionic  tufts  lying  in  contact  with  the  crypt  walls,  but 
quite  detached  therefrom,  with  the  fetal  and  maternal  epi- 
thelial layers  widely  separated,  as  shown  in  Figs.  33,  34. 
If,  however,  disease  has  invaded  the  placental  tissues,  the 
picture  promptly  changes;  the  damaged  fetal  and  maternal 
epithelia  or  their  debris  lie  in  contact,  and  placentitis  with 


72 


Diseases  of  the  Genital  Organs 


retained  or  adherent  placenta  is  present.  The  tendency  to 
retention  of  the  fetal  membranes,  when  placentitis  is  pres- 
ent, logically  increases  as  the  size  and  complexity  of  the 
chorionic  tufts  advance.  Thus  retention  of  the  fetal  mem- 
branes is  commonest  and  most  severe  in  the  cow,  and  in- 
creases in  severity  with  the  advancement  in  pregnancy.  It 
rarely  occurs  during  the  first  four  months  of  pregnancy,  but 
becomes  increasingly  common  as  the  duration  of  pregnancy 
increases.  The  simple,  short,  chorionic  tufts  of  solipeds 
tend  to  obviate  retention  of  fetal  membranes. 


Chapter  II 

THE  CLINICAL  EXAMINATION  OF 
THE  GENITAL  ORGANS 

A.  The  Clinical  Examination  of  the  Male  Genital  Organs 

The  clinical  examination  of  the  genital  organs  of  the  stal- 
lion and  the  bull  is,  as  a  rule,  best  made  with  the  animal  in 
the  standing  position  after  necessary  measures  have  been 
taken  for  the  safety  of  the  examiner.  Most  stallions  stand 
well  but  exceptions  are  sufficiently  numerous  to  dictate  that 
the  animal  be  securely  confined.  A  few  are  safe  when  care- 
fully held  by  bridle  or  halter ;  some  are  controlled  by  the  ap- 
plication of  the  twitch  or  by  holding  up  a  fore  foot ;  some 
are  safe  only  when  side  lines  or  breeding  hobbles  are  applied. 
Even  with  these  the  examiner  must  be  on  his  guard.  The 
side  line  interferes  with  examination  from  that  side.  If  the 
examination  is  made  from  behind,  the  animal  may  forcibly 
lift  his  hind  foot  and  give  the  examiner  a  bad  blow  with  the 
summit  of  the  os  calcis.  The  stocks  make  an  ideal  method 
for  confining,  safe  alike  for  examiner  and  patient.  Very 
refractory  animals  may  need  to  be  cast  or  placed  upon  the 
operating  table. 

The  bull  is  to  be  confined  preferably  in  the  stanchion,  re- 
sorting to  the  use  of  the  leading  or  nose  ring  in  lieu  of  the 
twitch.  Sufficient  precautions  should  be  taken  against 
crowding  and  trampling  upon  the  examiner.  Kicking  with 
one  foot  may  be  conveniently  prevented  by  securing  a  rope 
upon  one  metatarsus,  carrying  it  once  around  the  other  meta- 
tarsus, and  having  a  man  hold  the  free  end.  The  animal  can 
be  promptly  released  if  he  falls. 

When  the  animal  is  properly  secured,  the  testicles  of  both 
stallion  and  bull  are  best  examined  from  behind  because 
both  glands  can  be  viewed  simultaneously  or  palpated  from 
the  same  point.  The  smaller  ruminants  are  readily  ex- 
amined standing;  carnivora  need  to  be  securely  controlled 
against  scratching  or  biting. 


74  Diseases  of  the  Genital  Organs 

1.    The  Testicles 

The  testicles  are  to  be  examined  with  reference  to  loca- 
tion, position,  volume,  consistence,  clearness  of  outline,  and 
evidences  of  heat,  pain,  and  swelling. 

It  is  a  well  established  clinical  principle  that,  in  order  to 
be  fertile,  there  must  be  one  testicle  in  the  scrotum.  It  is 
desirable  that  both  glands  be  in  the  scrotum  because  when 
one  is  retained,  owing  to  arrest  in  development,  the  progeny 
are  liable  to  inherit  the  defect.  The  testicles  of  the  foal  and 
the  calf  should  be  in  the  scrotum  at  birth.  The  position  of 
the  testicle  apparently  matters  but  little ;  at  least  occasion- 
ally the  testicle  of  the  stallion  is  observed  to  be  rotated  on 
its  transverse  axis  so  that  the  tail  of  the  epididymis  presents 
forward,  without  apparent  detriment.  In  one  bull,  the  tail 
of  the  testicle  was  caught  well  up  in  the  posterior  part  of  the 
scrotal  sac  and  the  large  end  of  the  gland  tipped  forward  to 
come  to  rest  in  the  position  of  the  stallion  testicle. 

In  volume,  the  two  testicles  of  the  horse  are  rarely  alike. 
Usually  the  right  gland  is  clearly  the  larger.  In  ruminants 
the  two  glands  are  more  nearly  alike.  The  size  varies  with 
the  size  of  the  animal,  the  breed,  the  age,  and  the  individual. 
It  is  only  when  the  glands  depart  widely  from  the  average 
volume  that  their  size  becomes  significant.  Even  then  the 
size  needs  to  be  considered  with  the  consistence.  They  be- 
come enlarged  in  orchitis,  abscessation,  etc.  When  arrest  in 
development  has  occurred,  they  are  usually  abnormally  small. 

The  consistence  of  the  testicle  is  highly  important.  Phys- 
iologically the  gland  is  very  firm  and  tense  and  its  contour 
is  clear  and  definite.  The  testicle  may,  from  inflammation, 
become  hard  and  unyielding,  or  in  advanced  abscessation, 
soft  and  fluctuating.  In  arrest  in  development  the  testicle 
is  generally  small  and  flaccid.  This  is  commonly  so  in  the  ab- 
dominal testicle  but  is  observed  also  in  arrest  in  development 
of  scrotal  testicles.  Such  testes  do  not  form  spermotozoa 
but  do  (commonly,  at  least)  induce  sex  reflex.  If  a  healthy 
male  of  similar  age  and  size  is  available  for  comparison,  the 
examination  may  thus  be  rendered  more  accurate. 


The  Epididymis  75 

2.    The  Epididymis 

The  epididymis  and  scrotal  section  of  the  vas  deferens  are 
also  palpable.  The  commonest  point  for  the  lodgment  of 
chronic  infections  is  in  the  tail  of  the  epididymis  which 
should  be  examined  accordingly  with  special  care. 

In  the  stallion,  bull,  and  perhaps  other  males,  there  is  a 
tendency  towards  the  obliteration  of  the  peritoneal  sac  of 
the  scrotum  due  to  adhesions  between  the  parietal  and  vis- 
ceral layers  of  peritoneum.  This  lessens  or  destroys  the  mo- 
bility of  the  gland  within  its  peritoneal  sac  but  the  very  loose 
areolar  fascia  between  the  cremaster  and  the  dartos  and 
.  skin  leave  the  testicle,  with  the  adherent  parietal  peritoneum 
and  the  closely  applied  cremaster,  movable  within  the  dartos. 
The  adhesions  between  the  two  peritoneal  layers  are  not 
very  readily  diagnosed  and  accordingly  careful  search  should 
be  made. 

The  size  of  the  penis  is  not  generally  of  clinical  import- 
ance, but  it  is  occasionally  so  large  in  the  stallion  that  it  im- 
perils the  vagina  of  the  mare.  This  can  be  best  determined 
by  bringing  a  mare  into  the  presence  of  the  stallion  and 
causing  complete  erection,  when  the  examiner  can  make  a 
reasonable  estimate  of  the  safety  or  danger  when  mated 
with  a  mare  of  a  certain  size.  In  some  cases  urethral  hemor- 
rhage follows  coitus  so  that  it  is  essential  to  cause  the  ani- 
mal to  copulate  in  order  to  render  the  examination  effective. 

An  examination  of  the  relaxed  penis  of  the  horse  may  be 
made  by  passing  the  hand  up  through  the  sheath  into  the 
prepuce  and  grasping  the  glans  firmly  behind  the  corona. 
By  exerting  moderate  traction,  sometimes  for  several  min- 
utes, the  retractor  muscle  becomes  fatigued  and  the  penis 
can  be  completely  exposed  and  examined.  If  the  organ  is 
moist  and  not  readily  grasped  with  the  hand,  the  hold  may 
be  rendered  secure  by  wrapping  the  penis  in  a  dry  towel  or 
a  piece  of  gauze. 

The  S-curved  penis  of  ruminants  cannot  ordinarily  be  ex- 
amined satisfactorily  while  the  patient  is  standing.  Copula- 
tion is  virtually  instantaneous  so  that  only  a  hurried  glance 
can  be  had  at  such  times.    The  sheath  is  so  narrow  that  the 


y6  Diseases  of  the  Genital  Organs 

glans  cannot  be  reached  and  grasped  with  the  hand.  The 
animal  is  to  be  confined  in  lateral  recumbency,  with  the  an- 
terior limbs  extended  forward  and  the  posterior  limbs,  back- 
ward, thus  completely  exposing  the  ventral  surface  of  the 
body  and  giving  the  operator  free  and  safe  access  to  the 
parts.  The  bull  is  best  extended  by  placing  him  between 
two  strong  posts  or  other  solid  points  for  attachment  and 
stretching  the  limbs  by  means  of  two  stout  ropes,  one  ex- 
tending from  the  hind,  and  the  other  from  the  fore  feet  to 
the  corresponding  posts.  The  penis  is  then  to  be  exposed  by 
eliminating  the  S-curve  and  pushing  the  sheath  backward. 
The  elimination  of  the  sigmoid  flexure  is  accomplished  by 
grasping  the  distal  curve  at  the  point  of  insertion  of  the  re- 
tractor muscle  and,  pushing  firmly  upward  and  forward, 
fatigue  the  muscle  until  it  finally  yields  and  the  glans  penis 
moves  forward.  The  tissues  about  the  sheath  opening  are 
then  to  be  pressed  backward  toward  the  scrotum,  thus  short- 
ening the  sheath ;  the  two  movements  combined  serve  to  ex- 
pose the  glans.  A  piece  of  dry  gauze  wrapped  about  the 
glans  enables  the  operator  to  grasp  it  firmly,  and  by  the  ex- 
ertion of  moderate  and  prudent  traction  the  retractor  muscle 
may  be  kept  in  a  state  of  fatigue  and  the  penis  fully  exposed. 
It  can  then  be  examined  leisurely  and  carefully.  The  com- 
plete exposure  of  the  penis  also  exposes  fully  the  mucosa  of 
the  prepuce  and  sheath  which,  as  shown  in  Fig.  9,  now  con- 
stitutes the  covering  of  the  body  of  the  penis  from  the  glans 
backward. 

3.    The  Seminal  Vesicles,  Prostate,  and  Cowper's 
Glands 

The  abdominal  vas  deferens,  the  vesicula  seminalis,  and 
the  prostate  gland  may  be  palpated  per  rectum  in  the  stal- 
lion and  the  bull.  The  prostate  may  be  palpated  digitally 
per  anum  in  the  dog.  In  the  stallion  and  the  bull  the  vas 
deferens  may  be  palpated  as  it  emerges  from  the  internal 
inguinal  ring  and  passes  upward,  forward,  and  inward  to 
reach  the  superior  surface  of  the  neck  of  the  urinary  blad- 
der, where  it  passes  backward  to  disappear  beneath  the  cor- 
responding vesicula  seminalis. 


The  Semen  ajid  Sper77iatozoa  77 

4.    The  Semen  and  Spermatozoa 

The  satisfactory  examination  of  the  male  genitalia  ordi- 
narily involves  an  examination  of  the  semen.  This  is  best 
accomplished  by  causing  the  male  to  copulate  with  a  female 
and  removing  immediately  some  of  the  semen  from  the 
vagina.  This  may  be  conveniently  attained  by  introducing 
a  sterile  swab,  like  that  used  in  diphtheria,  deeply  into  the 
vagina.  Then  withdraw  the  swab  and  from  it  make  a  smear 
on  an  ordinary  slide,  apply  a  cover  glass  and  examine  under 
moderate  magnification.  If  the  examination  is  made  in  a 
warm  room  and  the  preparation  is  kept  moist  by  adding  a 
few  drops  of  physiologic  salt  solution,  healthy  spermatozoa 
continue  to  move  vigorously  during  a  period  ample  for  study 
of  the  living  cells.  If  the  semen  is  kept  warm  and  moist,  it 
may  be  carried  some  distance  and  examined  after  several 
hours.  It  is  best,  however,  to  examine  the  semen  as  to  mo- 
tility soon  after  ejaculation. 

The  quantity  of  semen  ejaculated  is  likewise  of  funda- 
mental importance  in  judging  the  fertility  of  a  sire.  While 
technically  but  one  spermatozoon  is  necessary  for  the  fer- 
tilization of  an  Q%%,  there  are  physiologically  many  millions 
of  spermatozoa  for  each  ovum.  The  luxurious  numbers 
serve  as  a  safeguard  against  their  total  destruction  during 
the  hurried  migration  from  the  vagina  to  the  ovary.  Not 
only  is  it  important  that  great  numbers  of  spermatozoa  shall 
be  present  in  order  to  make  it  certain  that  at  least  one  vigor- 
ous cell  will  reach  the  ovum,  but  great  numbers  constitute, 
under  certain  limitations,  an  indication  of  sexual  health  and 
vigor.  The  amount  of  semen  needs  to  be  determined  by  some 
form  of  approximate  measurement.  In  horses  and  cattle 
the  vagina  of  the  female  may  be  well  washed  out  with  sterile 
salt  solution  or  with  a  0.25%  chlorazene  solution  which  dis- 
solves the  vaginal  mucus,  followed  by  the  salt  solution,  and 
by  inserting  the  well  disinfected  hand,  the  animal  may  be 
caused  to  eject  all  fluid  or  it  may  be  ladled  out  with  the 
hand.  If  the  male  is  then  caused  to  copulate  with  her,  the 
contents  of  her  vagina  may  be  at  once  ladled  out  of  the 


yS  Diseases  of  the  Genital  Organs 

vagina,  measured,  and  a  fair  approximation  of  the  volume 
of  semen  ejaculated  obtained.  If  the  vagina  has  not  been 
cleaned  out  immediately  prior  to  coitus,  no  accurate  idea 
can  be  had  of  the  volume  of  the  semen  because  there  may  be 
several  ounces  of  thin  mucus  or  other  fluid  lying  in  the 
vagina.  Studied  under  this  plan,  the  bull  ejaculates  as  a 
rule  6  to  8  mils  of  semen  at  a  copulation.  The  semen  con- 
sists largely  of  the  secretions  from  the  seminal  vesicles  and 
prostate  gland  in  which  the  spermatozoa  swim  freely.  If 
the  spermatozoa  are  dead  immediately  after  ejaculation, 
that  is  conclusive  evidence  of  sterility  but  does  not  reveal 
the  cause  of  the  sperm  death.  Living  spermatozoa,  how- 
ever abundant,  do  not  afford  final  proof  of  fertility.  Sperm- 
atozoa may  be  suffering  from  disease  and  their  elements 
undergoing  disintegration  and  death.  Or  there  may  be 
bacteria  ejaculated  in  the  semen  capable  of  causing  the 
death  of  most  or  all  spermatozoa.  It  is  accordingly  essential 
to  accurate  diagnosis  that  the  spermatozoa  shall  be  so  pre- 
pared by  staining  and  otherwise  that  their  structural  de- 
tails may  be  carefully  and  effectively  studied.  The  various 
parts  need  to  be  rendered  clear  so  that  any  commencing  de- 
generation may  be  detected. 

The  degeneration  of  the  spermatozoa  and  their  capacity 
to  fertilize  is  not  the  end  of  the  question.  There  is  striking 
clinical  evidence  that  stallions,  apparently  in  good  general 
health,  transmit  venereally  to  mares  the  infection  of  epizoo- 
tic cellulitis  or  "pink  eye"  and  at  the  same  time  prohibit  fer- 
tilization. Some  sterile  bulls  apparently  render  sterile  the 
females  which  they  have  unsuccessfully  served. 

It  is  important  that  the  copulatory  act  be  closely  observed 
so  as  to  determine  whether  it  is  normal — that  there  is  the 
normal  sexual  desire  and  ejaculation,  followed  by  normal 
relaxation.  Any  hesitancy  in  copulation  should  be  carefully 
noted  and  its  cause  determined  if  possible.  Imperfect  coitus 
may  arise  from  physical  difficulty  in  mounting  the  female 
due  to  painful  diseases  of  the  hind  feet  or  limbs,  or  to  paral- 
ysis. The  difficulty  may  be  due  to  mechanical  interferences 
with  the  protrusion  of  the  penis.    In  other  instances  there  is 


The  Semen  aiid  Spe?'matosoa  79 

such  pain  in  protruding  the  penis  or  in  ejaculating  semen, 
that  the  animal  fails  to  copulate  properly.  The  examiner 
must  reach  a  proper  diagnosis  regarding  the  group  of  causes 
under  which  a  given  case  falls  and  search  in  detail  for  a  defi- 
nite solution  of  the  problem. 

B.   The  Clinical  Examination  of  the 
Female  Genital  Organs 

The  clinical  examination  of  the  genital  organs  of  the  mare 
and  the  cow  reveals  to  the  veterinarian  data  of  great  eco- 
nomic and  scientific  interest.  The  freedom  with  which  the 
veterinarian  may  palpate  the  entire  genital  system  per  rec- 
tum in  these  animals  gives  to  him  a  marked  advantage  over 
his  confrere  in  human  medicine  in  the  examination  of 
woman.  In  the  small  ruminants,  with  a  rectum  too  small  to 
admit  the  operator's  hand  and  a  tense  abdominal  tunic  which 
well-nigh  shuts  out  abdominal  taxis,  the  veterinarian  is 
placed  at  a  serious  disadvantage.  The  same  holds  true  of 
the  sow,  with  the  thick  skin  and  dense,  abundant,  subcu- 
taneous fat.  The  bitch  and  cat,  with  thin  flaccid  abdominal 
walls,  ofl'er  a  moderate  opportunity  for  palpation  of  the 
genital  organs,  but  far  inferior  to  that  enjoyed  in  the  mare 
and  cow. 

By  means  of  clinical  examination  of  the  genitalia,  espec- 
ially of  the  cow  and  the  mare,  the  veterinarian  is  enabled  to 
diagnose  estrum,  ovulation,  pregnancy,  and  innumerable 
genital  diseases. 

Most  mares  and  cows  will  stand  quietly  for  both  rectal 
and  vaginal  examination,  but  the  prudent  veterinarian  will 
take  no  unnecessary  risks.  The  danger,  usually  greatest  at 
the  commencement  of  the  examination,  is  far  greater  in  the 
mare  than  in  the  cow.  The  chief  danger  is,  of  course,  from 
kicks.  The  greatest  resistance  is  generally  offered  when  the 
hand  is  introduced  through  the  vulva.  As  a  rule  of  prac- 
tice, in  examining  the  mare,  one  assistant  should  hold  the 
head  securely  and  well  elevated,  another  should  hold  up  one 
fore  foot,  and  a  third  hold  the  tail  out  of  the  examiner's 


8o  Diseases  of  the  Genital  Organs 

way.  Should  the  mare  be  restless,  a  twitch  should  be  ap- 
plied, and  upon  the  least  show  of  viciousness,  breeding  hob- 
bles should  be  used  and  drawn  up  tight.  Even  then,  the 
veterinarian  should  have  care  that  she  does  not  give  him  a 
blow  with  one  or  both  os  calces.  The  operator  should  look 
carefully  to  having  abundant  room,  especially  that  the  mare 
may  not  crowd  him  against  a  wall,  and  also  that,  when  his 
arm  is  in  the  rectum,  she  shall  not  be  able  to  move  violently 
to  the  right  or  left  and,  by  pressing  her  buttocks  close  to  a 
post,  crush  his  arm. 

The  cow  does  not  often  kick  during  rectal  or  vaginal  ex- 
aminations, but  I  know  to  my  cost  that  exceptionally  she 
kicks  fiendishly  and  very  dangerously.  Next  to  the  worst 
kick  in  my  career  was  from  a  cow  while  I  was  attempting  to 
examine  her  genital  organs.  Usually  the  cow  can  be  con- 
trolled by  a  strong  stableman  grasping  her  muzzle  firmly,  or 
still  better  by  applying  a  leading  ring  or  pincers  to  her 
muzzle  and  pulling  firmly.  However,  a  few  vicious  cows 
need  to  be  shackled  by  tying  a  rope  or  strap  about  one  meta- 
tarsus, giving  it  a  turn  about  the  other,  and  then  having  a 
strong,  alert  man  hold  the  end  of  the  rope  firmly,  ready  in 
event  of  a  fall  to  release  her.  I  have  encountered  a  number 
of  heifers  which  were  exceedingly  resistant  to  the  instru- 
mental examination  of  the  cervico-uterine  cavity,  and  have 
found  it  necessary  to  lay  them  down  and  secure  them.  It  is 
inadvisable  to  waste  time  on  these  obstinate  patients,  be- 
cause the  longer  one  works  the  more  resistant  they  become. 
Finally  they  exhaust  the  operator  and  then,  if  ever,  he  is 
liable  under  fatigue  to  injure  the  patient  seriously.  There- 
fore it  is  best,  when  the  animal  cannot  be  controlled  in  a 
manner  to  render  both  patient  and  operator  safe  and  to 
avoid  fatigue,  that  the  animal  be  secured  in  lateral  recum- 
bency. She  may  be  cast  in  a  variety  of  ways,  but  for  con- 
venience of  securing  for  the  operation,  the  best  method  is 
that  of  stretching  her  between  two  posts.  The  head  should 
be  tied  securely  to  one,  with  a  second  post  or  other  fixed 
point  for  securing  a  rope  about  twenty  feet  or  more  behind 
her.    A  stout  rope  is  then  tied  in  a  running  noose  about  one 


Examination  of  Female  Genital  Organs  8i 

metatarsus,  and  a  half  hitch  taken  about  the  other.  Two  or 
three  strong  men  may  then  draw  regularly  and  firmly  upon 
the  rope,  gradually  stretching  the  animal  until  she  finally 
falls  upon  her  side.  The  process  is  rendered  easier  by  apply- 
ing a  second  rope  to  the  anterior  feet  and  having  a  man 
stretch  these  forward,  but  the  cow  may  then  fall  harder  and 
should  be  guarded  against  injury  by  an  ample  bed.  The 
ropes  drawing  upon  the  metatarsi  or  metacarpi  may  cause 
pressure  injuries  unless  the  precaution  is  taken  to  pad  the 
parts  beneath  the  rope,  which  is  conveniently  done  usually 
by  wrapping  the  part  with  a  grain  sack  before  applying  the 
rope.  Finally  the  rope  on  the  hind  feet  is  to  be  secured  to 
the  rear  post  and  that  on  the  fore  feet  to  the  front  post.  The 
operator  may  now  proceed  deliberately,  conveniently,  and 
safely  with  his  examination.  The  examination  of  the  recum- 
bent heifer  thus  secured  is  easier  and  safer.  In  the  well- 
behaved  heifer  the  advantage  of  securing  in  lateral  recum- 
be-ncy  is  more  than  counterbalanced  by  the  time  and  labor 
of  securing  and  the  peril  of  casting  injuries.  I  have  found 
it  necessary  to  secure  a  heifer  in  lateral  recumbency  three 
or  four  times  in  succession  for  examination  or  treatment, 
until  finally  she  yields  and  stands  without  resistance. 

The  preparation  of  a  special  stall  or  stanchion  into  which 
all  cows  in  an  establishment  may  be  led  for  examination  is  a 
great  convenience.  In  some  herds  a  sort  of  movable  stocks, 
somewhat  like  a  shipping  crate,  is  prepared,  which  can  be 
placed  anywhere  according  to  light  or  other  convenience,  or 
moved  from  one  stable  to  another. 

The  ready  introduction  of  the  hand  into  the  vulva  or  rec- 
tum requires  some  form  of  lubrication.  As  a  rule,  the  best 
is  a  warm  salt  solution  of  approximately  0.7  to  1  per  cent. 
Many  veterinarians  resort  to  soap  as  a  lubricant,  but  this  is 
undesirable  because  even  very  weak  soapsuds  almost  inevi- 
tably irritates  both  the  rectal  and  the  vaginal  mucosa  and 
causes  tenesmus — the  worst  foe  with  which  the  examiner 
must  contend.  The  addition  of  antiseptics  to  the  water  is 
much  worse  than  the  use  of  soap.  No  antiseptic  can  be  used 
of  such  strength  as  to  produce  even  very  feeble  disinfection 


82  Diseases  of  the  Genital  Orgayis 

without  causing  much  irritation  and  straining.  The  opera- 
tor may  use  antiseptics  on  his  hands  and  arms  to  cleanse 
them,  and  may  use  moderately  strong  antiseptic  solutions, 
if  desired,  about  the  exterior  of  the  anus  and  vulva,  but 
these  should  not,  as  a  rule,  be  carried  on  the  hand,  even  in 
small  amount,  into  the  rectum  or  vagina.  Oils  and  fats 
make  good  lubricants,  but  when  used  they  interfere  very 
seriously  with  the  sense  of  touch  in  the  vagina,  especially 
when  one  wishes  to  palpate  for  the  uterine  seal  or  to  deter- 
mine the  character  of  the  mucus  within  the  vagina.  Some- 
times, however,  lubrication  of  the  hand  with  oil  or  fat  is 
virtually  necessary,  especially  when  introducing  it  through 
a  very  narrow  vulva.  Powdered  elm  bark  suspended  in 
warm  water  has  a  lubricant  value  essentially  equal  to  that 
of  fats,  and  has  the  advantage  that  it  is  readily  washed 
away  with  water  without  the  use  of  soap.  Vaseline  and 
other  heavy  fats  make  very  bad  lubricants  because  of  the 
difficulty  of  getting  rid  of  them  after  using.  The  value  of 
any  examination  of  the  genital  organs  rests  absolutely  upon 
the  knowledge,  skill,  and  care  in  every  detail.  The  veteri- 
narian needs  a  thorough  knowledge  of  the  anatomy  of  the 
entire  genital  system.  This  cannot  be  had  from  books  or 
lectures,  nor  in  the  anatomical  laboratory  of  a  veterinary 
college.  These  help  form  the  foundation,  but  in  order  to 
get  an  accurate  sense  of  the  form,  size,  density,  and  other 
attributes  of  the  living  organs,  the  veterinarian  needs  to 
examine  them  promptly  after  death.  The  abattoir  offers  an 
ideal  place  for  the  study  of  the  genitalia  of  cattle,  sheep,  and 
swine,  and  no  veterinarian  interested  in  the  diseases  of  their 
genital  organs  should  neglect  to  avail  himself  of  this  ideal 
opportunity  for  study.  Here  he  can  see  and  handle  non- 
gravid  uteri  and  uteri  in  every  stage  of  pregnancy,  and  by 
approximate  measurements  may  learn  to  recognize  with  fair 
accuracy  the  duration  of  pregnancy  by  the  transverse  dia- 
meter of  the  distended  uterus.  In  the  abattoir,  the  uterine 
seal,  the  corpus  luteum,  cysts,  ripe  and  freshly  ruptured 
ovisacs  may  be  recognized  and  their  character  studied  by 
sight  and  touch.     No  such   opportunity   for  fundamental 


Examination  of  Female  Genital  Organs  83 

knowledge  exists  elsewhere.  By  availing  himself  of  the 
freshly  slaughtered  animal,  the  veterinarian  makes  the 
closest  possible  approach  to  the  next  logical  step,  the  clinical 
examination. 

STERILITY-ABORTION 

ORIGINAL   EXAMINATION 


Owner. Address. - _.... 

Name  or  Herd  Number  of  Animal Date  of  Birth _ 

Has  animal  been  pregnant  ? If  she  has  bred,  state  number  of  calves  produced 

_ Date  of  termination  of  last  pregnancy 

Duration  of  last  pregnancy  in  days _ _ Was  calf  alive  or  dead  ? 

If  living,  was  it  healthy? Did  cow  have  retained  afterbirth  ?. 

or  discharge  from  uterUS? 

If  a  heifer  which  is  not  known  to  have  been  pregnant,  insert  in  chart  the  date  or  dates  of  service  or 
in  case  of  estrum  or  "heat"  and  not  served  write  date  in  parenthesis  (  ).  In  animals  which  have 
been  pregnant,  indicate  the  dates  of  service  since  calving  or  aborting  and  dates  of  estrum  when  not 
served,  as  in  the  heifers. 


Year 

J... 

Feb. 

„.. 

-■ 

- 

June 

JULV 

Aug. 

Sept. 

Oct. 

Nov. 

- 

1              1              1              1              1              1              1              1              1              1              1              1 

1              1              1              1              1              1              1              1              1              1              1              1 

Character  of  estrum,  regular  or  irregular 

General  condition State  of  lactation 

Date  of  Examination 

Right  broad  ligament Left  broad  ligament. 

Vulva - .„.. Vagina      

Cervix _... Uterus 


Right  ovary _ 

Right  oviduct „_ _ _ _ ._ , 

Left  ovary _ _ _ _ _._. 

Left  oviduct.. _ _ „ ._ 

Diagnosis ^...      Prognosis 

Treatment  applied ._ _ „ _ 

Treatment  advfsed _.._ _ 

Remarks : 

Fig.   37 — Examination  Blank  for  Recording   Findings  in   the 
Examination  of  the  Genitalia  of  Cows.     Reduced. 


84  Diseases  of  I  he  Genital  Organs 

There  is  no  field  of  veterinary  practice  where  system  and 
detailed  permanent  records  are  so  essential  to  efficiency. 
The  precise  order  of  examination  needs  to  be  varied  some- 
times according  to  the  individual,  but  generally  a  definite 
order  may  be  followed  from  beginning  to  end.  I  have  found 
the  examination  blank,  shown  in  Fig.  37,  convenient  in  mak- 
ing a  systematic  and  complete  examination.  After  the  iden- 
tity and  the  history  of  the  animal  have  been  satisfactorily 
recorded,  any  evidences  of  abnormality  in  the  broad,  or 
sacro-sciatic  ligaments,  such  as  their  sunken  condition  in 
nymphomania,  with  external  evidences  of  vulvar  disease  are 
noted. 

1.    Examination  of  Vulva  and  Vagina 

It  is  generally  advisable  next  to  insert  the  hand  into 
the  vagina  and  carefully  palpate  and  record  findings 
in  the  vulva,  vagina,  and  os  uteri  externum.  Unless 
palpation  reveals  counter-indications,  the  twenty-inch 
uterine  forceps  should  be  introduced  alongside  the  hand 
already  within  the  vagina  and  the  cervix  grasped.  This 
is  best  accomplished  by  pushing  the  index  finger  against 
or  into  the  os  uteri  externum.  With  the  forceps  slightly 
open,  push  the  one  jaw  into  the  os  far  enough  to  se- 
cure a  firm  hold  upon  its  lip  and  then  close  and  lock  the 
forceps.  In  some  heifers,  the  vaginal  portion  of  the  cervix 
forms  such  a  sharp  cone,  and  the  cervical  canal  is  so  narrow, 
that  the  tip  of  the  forceps  jaw  cannot  be  inserted  sufficiently 
to  grasp  the  cervix.  In  such  cases  the  forceps  should  be 
opened  wide  enough  to  grasp  the  cervical  cone  at  the  side 
near  its  base. 

Moderate  traction  upon  the  forceps  draws  the  cervix, 
uterus,  and  ovaries  backward  four  to  ten  inches,  stretches 
the  uterus  in  its  ligaments,  renders  its  outline  clearer,  and 
brings  the  ovaries  into  a  more  accessible  position.  When 
an  ovary  is  unusually  large  and  the  abdomen  pendulous,  the 
gland  frequently  drops  forward  and  downward  where  the 
examiner  cannot  reach  it  or  can  do  so  only  with  great  diffi- 
culty not  devoid  of  peril  to  the  rectal  walls.     The  traction 


Examiyiation  of  Vulva  and  Vagina  85 

with  the  forceps  usually  draws  the  uterus,  the  apices  of  the 
cornua,  and  the  ovaries  up  into  the  pelvis  or  against  the 
pubic  brim,  where  they  are  readily  palpated.  At  about  the 
90th  to  the  120th  day  of  pregnancy,  the  fetus  is  sometimes 
far  forward  in  the  gravid  cornu  and  the  uterus  has  fallen 
down  in  a  pendulous  abdomen,  where  it  is  difficult  to  palpate, 
making  error  in  diagnosis  easy.  Here  again  the  traction 
upon  the  cervix  tenses  the  genital  tube  so  that  it  may  be 
readily  followed  and  brings  up  within  reach  the  gravid  por- 
tion of  the  horn,  where  its  volume  may  be  recognized  and 
the  approximate  duration  of  pregnancy  determined. 

There  are  some  important  exceptions  to  this  order  of  pro- 
cedure. In  heifers  with  narrow  vulvae,  and  perhaps  with 
considerable  hymeneal  stricture,  the  force  necessary  in  order 
to  introduce  the  hand  in  attaching  the  forceps  may  arouse  so 
great  an  irritation  as  to  induce  severe  and  obstinate  strain- 
ing, which  may  render  rectal  palpation  very  tiresome,  fre- 
quently inaccurate,  and  sometimes  impossible,  so  far  as  any 
reliable  findings  go.  With  heifers,  therefore,  I  generally 
prefer  to  postpone  the  vulvo-vaginal  palpation  and  omit  the 
application  of  the  forceps  to  the  cervix  until  after  the  rectal 
examination  has  been  attempted.  The  very  frequent  in- 
tense straining  may  thus  be  avoided.  The  traction  upon 
the  cervix  is  by  no  means  so  important  in  the  heifer  as 
in  the  cow.  The  uterus  of  the  non-pregnant  heifer,  unless 
long  sterile,  is  of  good  tone,  firm,  small,  and  lies  in  the  pel- 
vis within  easy  reach.  If  the  heifer  is  pregnant,  her  uterus 
virtually  always  remains  firm  and  retains  its  position  with 
a  portion  of  the  distended  organ  within,  or  just  in  front  of, 
the  pelvis,  where  it  is  readily  palpated  and  its  volume  recog- 
nized. In  a  large  proportion  of  pregnant  heifers,  reliable 
and  satisfactory  diagnosis  can  be  made  readily  by  rectal 
palpation  without  applying  forceps  to  the  cervix  or  insert- 
ing the  hand  into  the  vagina,  thus  rendering  these  super- 
fluous. 

If  the  heifer  is  not  pregnant  and  after  several  copulations 
her  sterility  is  deemed  serious  or  important,  the  vulvo-vagi- 
nal and  cervical  canals  and  the  uterine  cavity  need  to  be  ex- 


86  Diseases  of  the  Ge^iital  Organs 

amined  in  order  to  arrive  at  a  reliable  diagnosis.  The  vulva 
and  vagina  then  need  to  be  forcibly  dilated.  This  is  best 
done  with  the  hand.  After  lubricating  with  warm  oil,  fat,  or 
emulsion  of  elm  bark,  the  fingers  should  be  formed  in  a  cone 
and,  under  gradual  and  firm  pressure,  the  vulva  slowly  di- 
lated. In  extreme  cases  the  dilation  may  require  an  hour  or 
two,  or  may  demand  repeated  efforts  on  successive  days. 
Any  intelligent  helper  may,  under  proper  instruction  and 
caution,  undertake  the  work,  but  it  must  not  be  unduly 
rushed.  In  some  extreme  cases  I  have  inserted  the  uterine 
forceps  into  the  vagina  without  inserting  my  hand,  directing 
it  on  the  median  line,  from  side  to  side,  inclined  very  slightly 


Fig.  38— Bischoflf' s  Vaginal  Dilator. 

downward,  to  the  end  of  the  vagina.  Opening  the  forceps 
moderately  and  pressing  them  forward  against  the  cervical 
end  of  the  vagina,  closing  and  locking  them,  and  then  apply- 
ing gentle  traction,  I  have  occasionally  been  able  to  draw  the 
vaginal  portion  of  the  cervix  back  to  the  vulva,  where  it 
could  be  palpated  by  inserting  one  or  two  fingers  and  even- 
tually secured  by  guiding  the  second  pair  of  forceps  to  the 
part  by  palpation.  With  both  forceps  applied  to  the  cervix, 
the  vagina  may  be  visually  inspected  and  the  cervical  canal 
and  uterine  cavity  examined  instrumentally. 

In  some  heifers,  the  vulva  is  constricted  by  the  presence 
of  a  small  band  of  connective  tissue  or  aponeurosis,  located 
about  one-half  inch  from  the  margin  of  the  lips,  just  beneath 
the  vulvar  mucosa.  When  vulvar  dilation  is  attempted,  the 
veterinarian  encounters  this  firm,  small,  cord-like  structure, 
which  under  the  force  employed  cuts  into  his  hand.  I  have 
observed  this  in  one  family  of  Holstein  heifers,  the  members 
of  which  were  unusually  large  and  rugged,  where  the  vulvae 


Examhiatioyi  of  Vulva  and  Vagina  87 

were  so  constricted  by  this  cord-like  structure  that  a  small 
hand  could  not  be  inserted.  The  difficulty  was  overcome  by 
severing  the  cord  at  one  or  two  points.  I  encountered  one 
sterile  Jersey  heifer  of  breeding  age,  with  so  small  a  vulva 
that  I  could  not  insert  my  hand  at  all  and  so  small  an  anus 
that  I  could  not  palpate  her  genitalia,  per  rectum,  though  the 
heifer  herself  was  not  extremely  small.  Vulvo-vaginal  stric- 
tures occur  from  disease,  rendering  palpation  of  the  anterior 
end  of  the  vagina  impossible.    These  will  be  considered  later. 

Albrechtsen  makes  extensive  use  of  the  vaginal  speculum 
in  studying  the  vagina  and  cervix,  but  I  have  not  found  it  of 
great  value.  When  one  pair  of  the  uterine  forceps  is  alt- 
tached  to  the  right  and  the  other  pair  to  the  left  lip  of  the 
OS  uteri  externum,  traction  exerted,  and  the  forceps  pressed 
apart,  the  vulvar  opening  is  widely  dilated  and  in  almost  all 
animals  all  parts  of  the  vaginal  mucosa  and  the  vaginal  por- 
tion of  the  cervix  are  brought  into  view  more  clearly  than 
with  the  speculum.  The  visual  examination  of  the  vaginal 
end  of  the  cervix  may  be  further  facilitated  in  cases  of  need 
by  applying  a  third  pair  of  forceps  to  the  superior  margin  of 
the  cervical  border.  In  a  few  instances  of  a  very  narrow 
vulva  or  vagina,  a  speculum  of  sufficiently  small  size  may 
be  of  great  aid.  The  best  speculum  in  my  experience  for 
this  purpose  is  that  of  Bischoff's  Vaginal  Dilator,  shown  in 
Fig.  38. 

In  the  manual  examination  of  the  vulva  and  vagina,  the 
examiner  should  take  note  of  all  abnormal  contents  and  of 
abnormalities  of  the  vulvo-vaginal  mucosae  and  of  the  peri- 
vaginal tissues  and  organs.  Physiologically,  the  vagina  of 
the  cow  at  estrum  and  when  nearing  parturition  contains 
an  abundance  of  clear,  rather  fluid,  highly  lubricant  mucus. 
The  vagina  of  the  non-pregnant  cow  in  the  interval  between 
estrual  periods  contains  a  small  amount  of  lubricant  mucus. 
The  vagina  of  the  pregnant  cow,  except  when  nearing  par- 
turition, contains  a  highly  adhesive  mucus.  These  physio- 
logic variations  in  quantity  and  quality  of  vaginal  mucus 
need  to  be  learned  by  actual  clinical  observation  before  the 
various  pathologic  contents  may  be  readily  recognized. 


88  Diseases  of  the  Genital  Organs 

The  walls  of  the  vagina  are  physiologically  soft,  pliable, 
and  thin,  but  this  is  largely  comparative  which  the  examiner 
must  learn  to  appreciate  by  clinical  study.  In  severe  granu- 
lar venereal  disease  and  in  other  chronic  inflammatory  con- 
ditions, the  mucosa  and  entire  walls  become  thickened  and 
hard.  In  the  acute  vesicular  venereal  disease  the  vulva  and 
vagina  become  highly  sensitive  and  exceedingly  painful  to 
the  touch. 

In  order  that  these  variations  in  the  vaginal  walls  may  be 
recognized  by  palpation,  it  is  essential  that  the  organ  be 
flaccid.  It  is  impossible  to  determine  clearly  the  state  of 
the  vaginal  walls  while  the  patient  is  straining  violently. 
A  still  greater  impediment  to  palpation  of  the  vaginal  walls 
is  the  ballooning  or  inflation  of  the  vagina  with  air.  During 
inspiration,  if  the  vulva,  the  anus,  or  the  cervical  canal  is 
open,  air  may  be  drawn  into  the  vagina,  rectum,  or  uterine 
cavity  respectively,  and  the  involved  organ  become  greatly 
inflated  like  a  balloon.  These  inflations  appear  to  be  wholly 
involuntary,  but  the  tendency  for  them  to  occur  varies 
greatly  in  individuals.  Once  the  vagina  becomes  inflated, 
the  ballooned  organ  completely  fills  the  pelvis ;  the  walls  are 
hard  and  firm;  and,  except  for  the  rectum  above,  lie  in  imme- 
diate contact  everywhere  with  the  pelvis.  The  condition  of 
the  vaginal  walls  and  of  the  surrounding  tissues  or  organs 
cannot  be  determined  by  palpation  through  this  tightly 
stretched,  firm,  unyielding  structure.  Sometimes,  by  mov- 
ing the  hand  rapidly  and  vigorously  from  side  to  side  and 
slapping  the  tense  walls,  the  cow  or  mare  may  be  induced  to 
contract  the  vagina  and  expel  the  air.  If  the  cervix  is  seized 
with  forceps  and  drawn  backward,  the  vaginal  cavity  is 
largely  eliminated  and  the  air  forced  out.  The  air  may  be 
forced  out  of  the  vagina  by  exerting  manual  pressure  upon 
the  ballooned  organ  from  the  rectum.  In  many  cases  the 
evacuation  of  the  air  from  the  vagina  is  none  too  readily  ac- 
complished, but  it  must  be  done  before  the  palpation  of  the 
vagina  and  perivaginal  structures  can  be  accomplished.  The 
veterinarian  must,  therefore,  be  patient  and  persevere  until 
his  object  has  been  attained.     Through  the  flaccid  vaginal 


Rectal  Palpation  89 

walls,  the  examiner  may  recognize  perivaginal  abscesses  of 
lymph  glands,  tumors,  pelvic  fractures,  diseases  of  the  uri- 
nary bladder,  ureters,  and  other  organs.  In  advanced  preg- 
nancy in  the  cow,  the  head  of  the  fetus  commonly  lies  in  the 
pelvis  above  the  vagina,  as  shown  in  Plate  I,  possibly  mis- 
leading the  unwary  veterinarian  and  causing  him  to  suspect 
extra-uterine  pregnancy. 

2.    Rectal  Palpation 

The  palpation  of  the  genitalia  of  the  cow  per  rectum  is  on 
the  whole  the  most  important  part  of  the  clinical  examina- 
tion, because  it  reveals  such  an  extended  list  of  data.  The 
essential  preliminaries  to  rectal  palpation  of  the  genitalia 
are  that  the  rectum  shall  be  empty  of  feces,  that  it  shall  not 
be  ballooned  with  drawn-in  air,  and  that  straining  or  tenes- 
mus shall  not  be  present.  Some  have  advised  emptying  the 
rectum  by  means  of  an  enema,  but  the  liquid  is  rarely  all 
evacuated  until  after  the  operator  inserts  his  hand,  at  which 
time  the  liquid  feces  are  often  forced  out,  causing  unpleasant 
soiling.  Hess  recommends  inserting  the  hand  into  the  anus 
in  the  form  of  a  cone,  spreading  the  fingers  apart  and  di- 
lating the  anal  ring  enough  to  admit  some  air  which  is  com- 
monly followed  by  defecation.  But  one  must  wait  for  a 
time  and  although  defecation  finally  occurs,  quantities  of 
feces  usually  still  remain  in  the  rectum  which  must  be  in- 
vaded for  successful  palpation.  It  is  essential  that  the  rec- 
tum be  emptied  as  far  as  the  operator  wishes  to  insert  his 
hand  and,  in  the  end,  this  must  be  accomplished  largely  by 
the  manual  removal  of  the  feces. 

The  ballooning  of  the  rectum  is  an  annoying  impediment 
to  rectal  palpation,  holding  the  examination  completely  in 
abeyance  so  long  as  it  persists.  Rapid  movements  of  the 
hand,  as  suggested  for  ballooning  of  the  vagina,  frequently 
suffice,  causing  the  rectum  to  contract  and  expel  the  air. 
The  ballooning  generally  involves  but  twelve  to  sixteen 
inches  of  the  rectum  at  the  anal  end,  and  the  operator  may 
reach  beyond  into  an  empty  section  of  the  gut,  cautiously 
engage  his  fingers  in  the  intestinal  folds,  and,  drawing  the 


go  Diseases  of  the  Genital  Organs 

anterior  segment  of  the  rectum  analward,  force  the  air  out 
of  the  ballooned  portion.  Patience  must  be  exercised  until 
the  ballooning  is  completely  overcome.  It  is  useless  to  at- 
tempt palpation  while  it  exists,  because  the  rectal  walls  are 
so  stretched,  hard,  and  firm  that  reliable  operation  is  simply 
impossible. 

Tenesmus,  or  straining,  also  inhibits,  so  long  as  it  lasts, 
any  reliable  palpation  of  the  genital  organs.  It  has  already 
been  remarked  that  soapsuds,  antiseptics,  etc.,  must  not  be 
introduced  into  the  rectum  on  the  hand,  arm  or  otherwise, 
since  they  may  cause  very  annoying  straining.  It  has  also 
been  noted  that  if  force  has  been  used  in  dilating  the  vulvo- 
vaginal tract  of  a  heifer  just  prior  to  rectal  exploration,  the 
pain  already  caused  in  the  genital  tract  will  result  in  vio- 
lent, and  frequently  uncontrollable  straining  during  rectal 
palpation.  These  causes  must  be  avoided.  But  when  the 
hand  can  be  readily  introduced  into  the  vagina  and  the  for- 
ceps fixed  in  the  cervix,  any  moderate  traction  exerted  tends 
to  prevent  rather  than  to  cause  straining.  Gentleness  and 
patience  are  the  chief  factors  in  controlling  straining.  Dur- 
ing straining  the  operator  should  always  let  his  hand  lie 
perfectly  passive  in  the  rectum.  He  must  not  even  use 
force  to  retain  a  position  already  reached.  If  his  fingers 
are  in  a  saccule  of  the  rectum  and  he  holds  his  hand  rigidly 
in  position,  the  cow  will  rupture  her  rectum  against  his 
finger  tips.  Even  with  the  greatest  gentleness  and  patience, 
one  sometimes  encounters  an  animal  which  strains  persist- 
ently and  violently.  One  cow  strained  constantly  during 
eff'orts  at  rectal  palpation  by  my  colleagues  and  myself,  and 
although  repeated  attempts  were  made  at  different  times, 
accurate  palpation  failed.  Peri-anal  injections  of  apoth- 
esene  and  moderate  chloral  enemas  both  failed.  Not  only 
accurate  work,  but  the  safety  and  life  of  the  patient,  are 
dependent  upon  the  gentleness  and  prudence  of  the  operator. 

It  is  virtually  impossible  sometimes  to  avoid  injuries  suf- 
ficient to  cause  hemorrhage  from  the  rectal  mucosa.  In 
small  heifers  the  anal  opening  seems  unduly  constricted  and 
at  some  point  the  mucosa  may  tear  and  slight  hemorrhage 


Rectal  Palpatio7i  91 

result,  but  this  is  extremely  rare.  Injuries  to  the  rectal 
mucosa  from  the  palpation  are  far  more  common.  Veteri- 
narians with  very  large  hands  and  arms  should  not  under- 
take rectal  palpation  of  the  genitalia  per  rectum  in  small 
heifers.  As  a  rule,  however,  bleeding  from  the  rectal  mu- 
cosa is  not  due  to  a  big  hand,  but  to  roughness,  inexperience, 
or  untrimmed  finger  nails.  The  nails  are  to  be  trimmed  to 
the  quick  and  carefully  filed  until  they  are  as  smooth  as 
possible,  softened  in  warm  water,  and  then  all  possible  care 
and  gentleness  must  be  used.  Under  no  conditions  is  the 
rectum  to  be  dragged  upon  violently.  While  it  is  ballooned 
or  the  cow  is  straining,  no  reliable  palpation  can  be  accom- 
plished, but  severe  or  fatal  injury  is  always  impending. 

Even  if  the  injury  is  not  serious,  hemorrhage  is  a  dis- 
credit to  the  examiner.  When  he  removes  his  hand,  covered 
with  blood,  it  looks  bad  to  the  owner,  and  to  one  who  knows 
the  subject  it  shows  that  the  examiner  has  failed  to  attain 
his  object,  which  is  a  reliable  palpation,  but  has  instead  in- 
jured the  rectum.  The  prudent  veterinarian  will,  therefore, 
have  care  to  reduce  to  a  minimum  the  frequency  and  amount 
of  hemorrhage  from  the  rectal  mucosa,  and  will  always  feel 
that  he  has  erred  whenever  his  hand,  when  withdrawn,  is 
stained  with  blood.  After  other  precautions  to  prevent 
straining  have  failed,  it  may  sometimes  be  controlled  by 
pinching  the  skin  of  the  back,  pressing  over  the  spine  with  a 
rough  stick,  pinching  the  muzzle  with  the  fingers  and  thumb 
in  the  nostrils,  or  applying  a  leading-ring  to  the  nose. 

When  the  foregoing  preliminary  precautions  against  in- 
jury to  the  intestines  have  been  made  and  other  preparations 
for  rectal  palpation  satisfactorily  attained,  the  examiner  is 
ready  to  proceed  with  the  palpation  of  the  genital  organs 
per  rectum.  If  forceps  have  been  applied  and  slight  trac- 
tion is  exerted,  the  cervix  of  the  non-pregnant,  adult  cow 
may  usually  be  drawn  back  almost  or  quite  to  the  vulva. 

There  are  occasional  exceptions.  In  Shorthorn  cows,  the 
vagina  is  quite  long  and  narrow  and  the  uterus  is  held  far 
forward  by  its  ligaments  so  that  in  many  individuals  it  is^ 
very  difficult,  and  sometimes  impossible,  to  draw  the  cervix 


92  Diseases  of  the  Genital  OrgaJis 

far  enough  back  to  permit  of  visual  examination  or  of  de- 
sired manipulations. 

When  the  operator  inserts  his  hand  into  the  rectum,  the 
logical  starting  point  for  the  palpation  is  the  cervix.  With 
the  forceps  applied  to  the  vaginal  end,  the  operator  may 
recognize  the  structure  by  following  the  instrument  to  its 
point  of  attachment.  When  the  forceps  have  not  been  ap- 
plied, as  in  heifers,  the  cervix  must  be  sought  and  recognized 
by  its  location,  size,  consistence,  and  attachments.  Without 
traction  with  the  forceps,  the  vaginal  end  of  the  cervix  lies 
eight  to  twelve  or  more  inches  anterior  to  the  vulva.  In  the 
non-pregnant  heifer,  it  ordinarily  lies  not  more  than  eight 
inches  from  the  vulva;  in  old,  pregnant  cows,  it  may  be 
dragged  far  forward  out  of  the  pelvic,  into  the  abdominal, 
cavity.  Similar  displacement  may  exist  in  pyometra,  hydro- 
metra,  large  ovarian  and  uterine  tumors,  and  other  patho- 
logic conditions.  Not  infrequently,  portions  of  the  small  in- 
testines are  pushed  back  in  the  recto-vaginal  pouch,  and 
must  be  dislodged  forward  before  the  cervix,  uterus,  or 
ovaries  may  be  palpated.  Ordinarily  it  is  a  very  easy  task 
to  dislodge  these  by  applying  very  slight  intermittent  pres- 
sure downward  and  forward. 

When  the  urinary  bladder  is  empty,  the  cervix  may  lie 
upon  the  empty  viscus,  but  it  is  generally  slightly  deviated  to 
the  right  and  rests  upon  the  pelvic  floor.  When  the  urinary 
bladder  is  distended,  the  cervix  (and  uterus)  is  almost  al- 
ways deflected  to  the  right  and  lies  in  the  furrow  between 
the  distended  viscus  on  its  left,  and  the  right  pelvic  wall. 
Rarely  the  cervix  and  uterus  lie  upon  the  distended  urinary 
bladder  or,  yet  more  rarely,  may  be  displaced  to  the  left. 
Sometimes  the  greatly  distended  urinary  bladder,  containing 
four  or  more  quarts  of  urine,  almost  fills  the  pelvis,  the  cer- 
vix and  uterus  fall  far  down  between  the  bladder  and  pelvis, 
and  the  bladder  rolls  or  extends  over  to  the  right,  virtually 
covering  the  cervix  and  uterus.  The  distended  bladder  then 
needs  to  be  pushed  to  the  left  in  order  to  palpate  the  cervix 
and  uterus.  Rarely  I  find  it  desirable,  before  satisfactory 
palpation  may  be  made,  to  catheterize  the  bladder  and  evacu- 


Rectal  Palpatio Ji  93 

ate  the  urine.  The  small  or  extra-small  Albrechtsen  uterine 
catheter  answers  the  purpose  satisfactorily. 

Sometimes  great  care  is  necessary  in  order  to  avoid  con- 
fusion on  account  of  the  bladder.  It  may  give  the  impression 
at  first  of  the  distended  pregnant  uterus,  and  the  examiner, 
off  his  guard,  may  fall  into  a  very  embarrassing  error.  His 
safety  is  assured  only  by  the  clear  recognition  of  the  cervix 
and  uterus.  When  the  urinary  bladder  is  empty,  it  forms  a 
flattened,  pear-shaped  body,  palpable  beneath  the  cervix, 
about  three  to  four  inches  long,  rather  firm  in  consistency, 
and  finely  irregular,  due  to  the  wrinkling  of  the  mucosa  and 
contracted  muscle  bands.  Then  follows  every  gradation  in 
size,  up  to  four  or  more  quarts  of  contents,  when  the  dis- 
tended organ  may  fall  over  the  pubic  brim  and  hang  down  in 
the  abdomen. 

The  cervix  is  recognizable  by  palpation  as  a  very  firm,  al- 
most cartilaginous,  cylindrical  organ,  three  to  six  inches 
long,  and  one  to  three  or  four  inches  in  diameter.  In  heifers 
it  is  very  small  and  firm,  usually  about  three  to  three  and 
one-half  inches  long,  and  one  to  one  and  one-half  inches  in 
diameter.  With  age,  and  yet  more  with  disease,  it  increases 
in  all  its  diameters.  In  health,  owing  to  the  amplitude  of  its 
broad  ligaments,  the  organ  may  be  picked  up  per  rectum, 
and  virtually  its  entire  circumference  freely  palpated.  In 
disease,  it  may  be  adherent  in  varying  degrees  and  difficult 
of  clear  identification.  Behind,  the  cervix  is  continued  by 
the  flaccid,  empty  vagina.  Sometimes  the  inexperienced 
practitioner  may  be  confused  on  account  of  the  ballooned 
vagina,  which  has  already  been  mentioned.  The  cervix  is 
then  pushed  forward  by  the  ballooning  and  the  operator 
feels  beneath  the  rectum,  filling  more  or  less  completely  the 
pelvic  cavity,  a  moderately  tense,  inflated  sac,  which  he  may 
at  first  mistake  for  the  urinary  bladder  or  be  otherwise  mis- 
led. Traction  upon  the  cervix  with  the  forceps  pushes  the 
air  out  through  the  vulva,  or  it  may  be  readily  evacuated  by 
gentle  pressure  from  the  rectum. 

a.  The  Uterus.  Forward,  the  cervix  ends  in  the  usually 
somewhat  broader  and  markedly  softer  uterine  body.     In 


94  Diseases  of  the  Genital  Organs 

severe  cervicitis,  the  cervix  often  has  a  far  greater  trans- 
verse diameter  than  the  body  of  the  uterus. 

Just  in  front  of  the  cervix,  the  body  of  the  bovine  uterus 
is  small  and  inconspicuous  when  compared  with  the  size  of 
the  uterus  as  a  whole.  Externally  it  is  ordinarily  two  to 
three  inches  long,  but  the  originally  separate  Muellerian 
ducts  are  still  faintly  evident  upon  palpation,  in  the  form  of 
a  slight  antero-posterior  depression  on  the  dorsal  surface. 
This  depression  gradually  deepens  into  a  distinct  furrow, 
soon  the  bifurcation  is  reached  and  the  two  distinct  cornua 
follow,  constituting  the  chief  volume  of  the  uterus.  Each 
uterine  horn  has  about  sixty  per  cent  of  the  transverse  dia- 
meter of  the  body. 

The  examiner  recognizes  the  non-pregnant  uterus  by  its 
continuity  with  the  cervix  anteriorly,  its  bicornual  charac- 
ter, and  its  firmness  and  evenness  to  the  touch,  each  cornu 
forming  the  segment  of  a  circle  with  its  convex  border  pre- 
senting dorso-anteriorly.  In  the  healthy  uterus  of  the  heifer, 
the  uterine  body  and  horns  are  very  firm,  smooth,  regular, 
thus  serving  to  differentiate  them  clearly  from  all  other  pel- 
vic or  abdominal  viscera.  The  cornu  of  the  heifer  is  one- 
half  to  three-fourths  of  an  inch  in  diameter  at  the  base,  and 
tapers  gradually  to  a  fine  point  at  the  ovarian  end,  where  it 
passes  almost  imperceptibly  into  the  oviduct.  The  examiner 
should  trace  each  cornu  separately,  as  it  extends  obliquely 
forward  to  the  right  or  left,  where  it  soon  turns  downward, 
thence  backward  and  upward  by  a  regular  curved  line,  to 
end,  the  right  cornu  on  the  right  side,  the  left  cornu  to  the 
left,  in  close  proximity  to  its  base,  thus  describing  an  almost 
complete  circle.  The  healthy  cornu  of  the  heifer  is  eight  to 
ten  inches  long  on  its  convex  border,  thus  forming  an  in- 
complete circle  two  and  one-half  to  three  inches  in  diameter. 
The  entire  organ  may,  therefore,  be  picked  up  through  the 
rectal  floor  and  held  in  the  hollow  of  the  hand.  The  uterus 
of  the  cow  is  larger,  is  slightly  uneven  owing  to  longitudinal 
wrinkles,  and  may  be  slightly  sinuous  because  the  cornua  are 
longer  than  their  broad  ligaments.  That  is,  the  uterus,  once 
pregnant,  never  wholly  returns  to  the  original  form,  outline 


Rectal  Palpation  95 

and  volume  of  the  uterus  of  the  heifer.  Estrum,  pregnancy, 
and  disease  alter  profoundly  the  volume,  form,  position,  and 
consistency.  Whatever  the  changes  may  be,  the  basic  prin- 
ciples in  recognition  are  the  continuity  with  the  vagina  and 
cervix  and  the  fundamental  position,  attachments,  and  re- 
lations. 

h.  The  Oviduct.  The  healthy  oviducts  are  difficult  of  rec- 
ognition by  rectal  palpation,  but  under  favorable  conditions 
are  recognizable.  They  are  less  than  one-eighth  inch  in 
diameter,  sinuous,  very  smooth  and  firm.  Arising  almost 
imperceptibly  from  the  apex  of  the  cornu,  they  pass  lateral- 
ward,  in  front  of  and  below  the  ovaries  embedded  in  the 
ovarian  ventricle  or  pocket  of  the  broad  ligament,  as  shown 
in  Fig.  13. 

Passing  beyond  the  outer  or  lateral  extremity  of  the 
ovary,  it  bends  inward,  or  medianward,  so  that  the  pavilion 
of  the  tube  presents  toward  the  antero-lateral  surface  of 
that  gland,  with  one  of  the  fimbriae  of  the  pavilion  attached 
to  the  lateral  end  of  the  ovary.  When  either  pyosalpinx  or 
hydrosalpinx  is  present,  the  tube  becomes  distinctly  en- 
larged and  usually  readily  palpable.  The  distension  of  its 
lumen  or  the  thickening  of  its  walls  increases  not  only  its 
transverse  diameter  but  also  its  length.  It  then  becomes 
readily  recognizable  by  palpation  per  rectum  in  almost 
every  case.  Generally  the  infection  involves  the  pavilion 
and  also  the  ovarian  pocket,  causing  them  to  become  ad- 
herent to  the  ovary  in  varying  degrees. 

c.  The  Ovary.  The  palpation  of  the  ovaries  per  rectum 
logically  follows  the  examination  of  the  oviducts.  The 
glands,  which  in  the  cow  physiologically  lie  approximately 
in  the  position  indicated  in  Fig.  13,  are  to  be  recognized  by 
their  size,  form,  consistence,  and  attachments.  In  the 
healthy,  non-pregnant  heifer  or  cow,  the  ovary  usually  lies 
lateral  to  and  somewhat  below  the  dorsal  border  of  the  base 
of  the  uterine  cornu,  between  it  and  the  ascending,  lateral 
portion  of  the  pubis.  Usually  it  lies  upon  the  pubic  floor, 
near  the  brim,  or  just  beyond  in  the  abdominal  cavity,  at  or 
slightly  below  the  brim  of  the  pubis.     Pregnancy  and  dis- 


96  Diseases  oj  the  Ge7iital  Organs 

ease  greatly  modify  the  position  of  the  ovaries.  Anything 
which-  contributes  a  weight  in  excess  of  the  physiologic,  non- 
gravid  uterus,  oviducts,  or  ovaries  causes  the  latter  to  drop 
downward  and  forward.  The  extent  of  the  dislocation  is 
further  influenced  by  the  degree  of  pendulousness  of  the 
abdomen. 

The  ovary  swings  freely  in  its  attachments,  may  be  picked 
up  per  rectum  and  ordinarily  moved  freely  for  a  distance  of 
four  to  six  inches  or  more.  The  healthy  ovary  sometimes 
lies  hidden  in  the  ovarian  pocket  (mesosalpinx),  or  drops 
over  in  front  of,  and  down  beneath,  the  broad  ligament,  so 
that  manipulation  is  required  in  order  to  free  it  and  render 
accurate  palpation  possible.  Once  it  is  disentangled  from 
the  pocket  or  other  accidental  covering,  the  outline  of  the 
gland  is  very  free  and  the  examiner  may  recognize  clearly 
ripe  ovisacs,  the  crater  following  the  recent  rupture  of  an 
ovisac,  the  corpus  luteum  in  its  varying  stages  of  growth  and 
decline,  its  abnormalities  and  diseases,  its  adhesions  with  the 
pavilion  of  the  tube  and  diseases  of  the  ovary,  with  concur- 
rent diseases  of  both  ovary  and  oviducts. 

The  ripe  ovisac  of  the  cow  is  a  thin-walled,  yielding,  and 
readily  ruptured  cyst  of  three-eighths  to  one-half  inch  in 
diameter,  standing  well  above  the  ovarian  surface,  usually 
upon  the  convex  or  greater  border  of  the  gland.  The  crater 
resulting  from  the  rupture  of  an  ovisac  is  a  deep  pit  with 
somewhat  irregular  edges,  three-eighths  to  one-fourth  inch 
across  its  mouth.  The  fresh,  growing  corpus  luteum  is  very 
soft  to  the  touch.  Its  dome,  which  may  project  one-fourth 
inch  or  more  above  the  general  ovarian  surface,  is  about  one- 
fourth  inch  wide.  Upon  palpation,  it  feels  like  a  small, 
atonic  granulations  tumor.  Gradually  it  increases  in  diame- 
ter, becomes  firm,  and  after  about  ten  days  has  reached  its 
full  size  of  three-quarters  to  seven-eighths  of  an  inch.  The 
contiguous  covering  of  the  ovary  grows  over  the  corpus 
luteum.  The  latter  is  usually  spheroidal,  sometimes  ovoid, 
with  its  base  implanted  in  the  body  of  the  ovary.  The  yellow 
body  may  be  somewhat  dumb-bell  shaped  owing  apparently 
to  a  constriction  about  its  center,  due  to  a  narrow,  firm  open- 


Rectal  Palpation  gy 

ing  of  the  crater  when  the  ovisac  ruptured.  The  two  ovaries 
are  rarely  symmetrical ;  the  left  is  usually  the  smaller — not 
rarely,  minute, — no  larger  than  a  small  pea.  From  such  a 
minimum,  the  healthy  ovary  may  be  of  any  size,  up  to  two, 
or  even  three  inches  in  some  large  cattle. 

The  corpus  luteum  modifies  greatly  the  gross  volume  of  the 
ovary.  In  the  very  small  ovary,  the  corpus  luteum,  fully  de- 
veloped, may  increase  the  volume  of  the  organ  ten-  to  twenty- 
fold,  while  the  development  of  a  seven-eighths  inch  corpus 
luteum  in  an  ovary  of  two  inches,  though  actually  adding  the 
same  volume,  does  not  cause  the  great  comparative  increase 
in  size. 

The  healthy  corpus  luteum  of  the  non-pregnant  heifer  or 
cow  retains  its  maximum  volume  until  about  the  sixteenth  to 
eighteenth  day  after  ovulation,  when  it  atrophies  rapidly  for 
two  or  three  days,  and  at  twenty  to  twenty-two  days,  when 
it  has  decreased  to  one-fourth  or  three-eighths  of  an  inch  in 
diameter,  estrum  and  ovulation  recur.  After  the  corpus 
luteum  has  formed  as  a  solid  mass,  physiologically  it  remains 
solid  throughout  its  history.  It  is  solid,  firm,  and  somewhat 
elastic  to  the  touch. 

The  corpus  luteum  of  pregnancy  does  not  differ  (except  in 
color,  which  is  of  no  concern  here)  from  the  corpus  luteum 
of  estrum  in  its  general  characters,  but  in  duration  it  phys- 
iologically continues  unchanged  throughout  pregnancy  and 
for  thirty  to  sixty  days  thereafter,  when  it  atrophies  and 
estrum  and  ovulation  recur.  Pathologically,  the  corpus 
luteum  may  be  grossly  enlarged  to  even  two  or  three  inches 
in  diameter,  may  undergo  cystic  degeneration,  and  other- 
wise depart  from  the  normal  volume,  consistence,  and  char- 
acter. It  may  undergo  rapid  degeneration,  with  abnormally 
short  intervals  between  estrual  periods,  may  atrophy  dur- 
ing pregnancy  and  cause  ovulation  and  estrum,  may  shift  its 
position  and  sink  deeply  into  the  body  of  the  gland,  and  may 
persist  at  full  size  for  month  after  month,  even  to  years,  in- 
hibiting estrum  and  ovulation.  The  ovary  is  subject  to  such 
a  wide  variety  of  pathologic  changes  that  the  veterinarian 
needs  to  study  it  carefully  and  abundantly  both  in  the  abat- 
7 


98  Diseases  of  the  Genital  Orgayis 

toir  and  clinically  by  palpation  in  order  to  be  able  to  read 
every  change  in  the  gland  with  his  finger-tips  as  unerringly 
as  a  blind  man  reads  braille. 

The  rectal  palpation  of  the  uterus,  oviducts  and  ovaries  of 
cows  and  of  some  heifers,  is  greatly  facilitated  by  the  appli- 
cation of  the  forceps  to  the  vaginal  end  of  the  cervix  and  the 
exertion  of  moderate  traction  thereon.  The  traction  draws 
the  uterus,  oviducts  and  ovaries  backward  and  upward, 
tenses  the  uterine  horns  and  renders  their  outline  more  dis- 
tinct, and  enables  the  operator  to  study  all  parts  of  the  geni- 
tal tract  at  a  far  greater  advantage.  The  plan  avoids  many 
errors  in  diagnosis.  Some  veterinarians  fear  that  the  appli- 
cation of  the  forceps  to  the  cervix  of  a  pregnant  cow  and  the 
exertion  of  traction  is  dangerous,  but  I  have  failed  to  observe 
any  untoward  results.  Without  the  aid  of  forceps,  I  have 
seen  colleagues  mistake  gross  pyometra  for  pregnancy  and 
make  other  regrettable  blunders.  As  a  rule  of  practice, 
therefore,  rectal  palpation  of  the  genital  organs  should  regu- 
larly be  aided  by  traction  upon  the  cervix  with  forceps.  Cer- 
tain exceptions  arise.  It  has  already  been  noted  that  the 
genital  organs  of  a  heifer  with  a  small  vulva  may  be  ad- 
vantageously palpated  per  rectum  without  the  application 
of  the  forceps.  In  pregnancy  of  30  to  90  days,  one  maj^  gen- 
erally make  a  clear  diagnosis  without  applying  forceps. 
But  in  an  old  cow  with  a  pendulous  belly,  the  uterus  in  early 
pregnancy  may  be  dropped  too  far  forward  and  be  entirely 
too  flaccid  to  admit  of  safe  recognition.  To  add  to  the  diffi- 
culty, the  embryo  in  such  cows  may  be  located  in  the  apex  of 
a  horn,  quite  out  of  reliable  reach.  Then  the  operator  paws 
about  unconsciously  in  an  eff'ort  to  drag  the  uterus  back  per 
rectum  which  is  infinitely  more  dangerous  and  far  less  effi- 
cient than  traction  with  forceps. 

The  vaginal  and  rectal  palpation,  in  addition  to  revealing 
an  endless  category  of  pathologic  lesions,  serves  almost  al- 
ways to  determine  the  presence  or  absence  of  pregnancy.  If 
pregnancy  is  diagnosed,  the  examination  is  ordinarily  com- 
plete. If  the  animal  is  non-pregnant,  instrumental  search 
of  the  cervical  canal  and  uterine  cavity  is  necessarv  for  the 


"    Examination  of  the  Cervical  Canal  99 

complete  assembling  of  available  data  for  diagnosis  and 
prognosis.  During  vaginal  palpation,  the  operator  logi- 
cally palpates  the  os  uteri  externum  for  the  uterine  seal  as 
an  indication  of  pregnancy.  When  a  healthy  heifer  is  preg- 
nant 30  days  or  more,  if  the  examiner  will  press  the  tip  of 
his  index  finger,  ivithout  oil,  vaseline,  or  other  lubricant, 
against  the  os  uteri  externum  for  a  short  interval,  and  then 
carefully  withdraw  it,  he  is  able  to  recognize  in  the  os  a 
small,  highly  adhesive  seal.  The  seal  grows  and  expands,  be- 
coming more  and  more  recognizable  throughout  pregnancy. 
Its  presence  is  a  warning  against  the  invasion  of  the  cervi- 
cal canal  until  ample  evidence  is  at  hand  that  the  seal  is 
spurious. 

3.    The  Examination  of  the  Cervical  Canal  and 
Douching  the  Uterus 

Having  applied  the  uterine  forceps  either  to  the  lips  or  to 
the  sides  of  the  cervix,  and  satisfactorily  determined  that 
the  animal  is  not  pregnant,  the  operator  may  exert  traction 
and  draw  the  vaginal  end  of  the  cervix  back  to  the  vulva  or 
as  near  thereto  as  is  safe.  Continuing  a  safe  degree  of 
traction  and  drawing  the  handles  of  the  two  pairs  of  forceps 
apart,  he  brings  the  vaginal  end  of  the  cervix  into  view.  If 
there  is  good  light  from  a  window  behind  the  cow,  the  parts 
may  be  satisfactorily  examined  visually  or  in  the  absence  of 
efficient  natural  light,  one  may  secure  excellent  illumination 
by  using  a  reflecting  electric  lamp  on  an  extension  cord,  or 
an  ordinary  flash  light.  The  examiner  should  note  the  state 
of  the  mucous  membrane  at  the  os  uteri  externum.  In  the 
healthy  heifer,  the  vaginal  end  of  the  cervix  terminates  in 
a  sharp  cone,  at  the  apex  of  which  opens  the  very  narrow 
OS  uteri  externum  with  its  mucosa  everywhere  in  contact. 
The  index  finger  cannot  be  inserted  without  violence.  Usu- 
ally it  will  admit  for  a  short  distance,  without  resorting  to 
force,  a  smooth  sound,  one-fourth  inch  in  diameter.  The 
vaginal  mucosa  envelops  completely  the  entire  cone  of  the 
vaginal  portion  of  the  cervix  and  invaginates  slightly  into 
the  OS  uteri  externum. 


lOO  Diseases  of  the  Genilal  Ors^aiis 

After  a  cow  has  been  pregnant,  increasing  with  each  preg- 
nancy, the  relations  of  the  cervical  tissues  become  modified. 
The  second  annular  fold  of  the  cervical  mucosa  becomes  en- 
larged, both  elongated  and  thickened,  and  the  antero-poste- 


FiG.   39— Instruments  for  the  Examination  of  the  Genitalia  of  Cows. 

/,   20''  uteriue  forceps  ;  a,   I'alnier's  uterine  tlilalor,  inoditkd  ;   ,\  Ri)/.enuurs 
uterine  dressing  forcejxs  ;    /,  small  uterine  catheter. 

rior  grooves  become  comparatively  deeper,  cutting  the  ring 
into  a  series  of  deep,  pedunculated  lobes.  Eventually  these 
push  their  way  out  through  the  vaginal  ring  or  os  uteri  ex- 
ternum into  the  vagina.  The  vaginal  ring  now  serves  as  a 
band  surrounding  the  protruding  second  ring.  The  second 
ring  then  becomes  the  most  posterior  portion  of  the  cervix. 


Ex  a  m  in  a  tio  n  of  th  e  Cervica  I  Canal  i  o  i 

and  in  disease  may  project  three  to  four  inches  beyond  the 
original  os  uteri  externum  toward  the  vulva.  In  severe  dis- 
ease the  third  annular  fold  may  also  force  its  way  out 
through  the  vaginal  ring.  In  disease  these  everted,  swollen 
rings  of  cervical  mucosa  constitute  large,  cauliflower-like 


Fig.  4a  -Median  Long-itudinal  Sections  of  Cervices  of  Cows 

showing  the  Windings  of  the  Cervical  Canal. 

/,  The  vagina  ;  2,  lip  of  the  os  uteri  externum  ;  j,  first  annular  mucous  fold  ; 

4.  second  annular  mucous  fold. 

tumors.  The  healthy  mucosa  of  the  cervix  is  smooth,  of  a 
pinkish  hue,  paler  than  the  vaginal  mucosa.  Its  surface  is 
moist,  but  should  reveal  no  signs  of  pus.  During  estrum  the 
cervical  canal  is  dilated  and  filled  with  clear,  highly  lubri- 
cant mucus. 

The  deeper  portions  of  the  cervical  canal  may  be  examined 


Diseases  of  the  Genital  Organs 


c 


Fig.  42.     Rupture  of  Cervix  by  an  Amateur  in  an  etfort  to  "  Open  the 

Mouth  of  the  womb  "  followed  by  Chronic  Abscess  of  Cervix. 

(Tz'.,  Cervix  ;    A,   abscess  in    inferior  wall  of   cervix;     d.  ().,   aijproxiinate 

location  of  ovaries  lyinj<  above  the  uterine  li).(anients  ;    Ov,  Oi\    cystic 

oviducts  (hydrosalpinx)  whicli  were  causins.;  the  sterility  ; 

Cu.,  Cit.,  nterine  cornua. 


Examination  of  the  Cervical  Canal  103 

by  means  of  dilator,  catheter,  or  sound.  The  dilator  (Fig. 
39)  is  usually  preferable.  As  will  be  seen  in  Figs.  40,  41, 
the  cervical  canal  is  extremely  narrow,  sinuous,  and  at  times 
angular,  and  the  free  margins  of  its  annular  mucous  folds, 
directed  toward  the  vagina,  offer  serious  obstacles  to  the 
prompt  passage  of  an  instrument  into  the  uterus.  The 
canal  usually  extends  sharply  downward  and  forward,  very 
slightly  to  the  right,  for  one  to  one  and  one-half  inch ;  then 
bends  sharply  upward  and  forward,  and  thence  approxi- 
mately forward,  with  slight  divergences,  to  the  cavity  of  the 
uterus.  The  windings  of  the  canal  are  difficult  to  follow  and 
the  free  margins  of  the  annular  folds,  directed  toward  the 
vagina,  constitute  deep  culs-de-sac,  into  which  the  dilator 
tends  to  pass  and  its  progress  to  be  thus  arrested.  The 
operator  is,  therefore,  to  take  these  conditions  into  account 
and,  without  violence  or  force,  retreat  and  advance  at  vari- 
ous angles,  in  his  effort  to  follow  the  tortuous  canal  and 
evade  the  barriers  formed  by  the  mucous  folds.  Sometimes 
the  free  edges  of  the  mucous  folds  appear  to  become  pushed 
forward  by  the  instrument  into  the  lumen  of  the  canal  and 
occlude  it,  preventing  for  the  time  the  passage  of  the  instru- 
ment. In  disease,  the  annular  folds  often  become  so  hyper- 
trophied  and  their  bases  so  sclerotic  as  to  cause  acute  bend- 
ings  of  the  canal  and  to  close  quite  firmly  its  lumen,  making 
it  exceedingly  difficult  and  rarely  impossible  at  a  given  time 
to  pass  an  instrument  through  the  canal  into  the  uterus. 

The  operator  needs  to  be  patient  here,  as  well  as  skilful. 
Any  undue  force  may  rupture  the  cervical  wall  and  pene- 
trate the  surrounding  connective  tissue,  causing  pelvic  ab- 
scessation,  as  shown  in  Fig.  42,  with  extreme  peril  to  the 
physical  and  breeding  life  of  the  animal.  If  the  operation 
cannot  be  made  to  succeed  at  first  effort,  it  should  be  sus- 
pended for  the  time  and  undertaken  later.  I  have  worked 
for  an  hour  or  two  at  a  time,  four  or  five  times  in  succession, 
before  finally  succeeding  in  reaching  the  uterine  cavity. 
However,  it  is  always  infinitely  better  to  try  repeatedly,  and 
finally  fail,  than  to  use  force  and  ruin  the  animal,  not  so 
much  because  of  the  breeding  value  of  such  an  animal,  since 


I04  Diseases  of  the  Genital  Organs 

that  is  always  seriously  impaired  already,  but  because  the 
rupture  of  the  cervical  walls,  with  the  unpleasant  conse- 
quences attending,  leaves  an  ugly  stain  on  the  veterinarian's 
reputation.  If  the  passage  of  the  canal  is  very  difficult,  one 
should  not,  as  a  rule,  work  at  it  for  more  than  an  hour  or  an 
hour  and  a  half,  since  by  that  time  he  will  tend  to  injure  the 


Fig.  43.  Rupture  of  the  Uterus  with  Uterine  Catheter.  Cow. 
F.,  Vagina;  /,  lip  of  os  uteri  externum  ;  2.  first  annular  mucous  fold; 
J,  instrumental  rupture  in  the  roof  of  the  horn  ;  4,  instrumental  rupture  of 
the  floor  of  the  uterine  horn  ;  5,  mesometrium  enormously  thickened  and 
inflamed  ;  6,  cystic  corpus  luteum  with  adherent  cystic  oviduct  to  the  left ; 
7,  median  section  through  cystic  oviduct.  The  veterinarian  had  killed  the 
cow  douching  the  uterus  when  the  sterility  was  caused  by  the  inoperable 
hydrosalpinx. 

tissues  unwarrantably  if  he  continues  his  efforts  longer, 
and,  still  more  important,  he  becomes  fatigued.  A  fatigued 
operator  is  always  a  dangerous  operator.  If  prudent,  he  will 
not  accept  the  attendant  risks  which  he  inevitably  faces 
when  fatigued. 

When  the  examiner  has  succeeded  in  passing  the  uterine 
dilator,  the  catheter,  or  other  instrument  into  the  uterine 
cavity,  he  faces  the  danger  of  puncturing  the  uterine  wall. 


Examination  of  the  Cervical  Canal  105 

as  shown  in  Fig.  43,  and  invading  the  peritoneal  cavity.  In 
order  to  avoid  wounding  the  uterus,  the  operator  needs  to 
judge  well  the  approximate  length  of  the  cervix  and  when 
the  end  of  the  instrument  reaches  the  region  of  the  os  uteri 
internum,  it  should  be  directed  slightly  downward.  That  is, 
using  a  curved  instrument,  as  is  always  most  convenient  and 
safest,  the  operator  should  at  this  time  turn  the  instrument 
so  that  the  concave  side  of  the  curve  is  directed  downward. 
Ordinarily  no  metal  instrument  should  pass  far  beyond  the 
OS  uteri  internum.  In  the  ordinary  empty,  non-pregnant 
uterus,  the  downward  curvature  of  the  uterus  is  so  marked 
that  there  is  great  peril  of  puncturing  the  walls  if  the  instru- 
ment is  pushed  more  than  one  to  two  inches  into  the  uterine 
cavity.  In  addition  to  this  danger,  if  the  uterus  is  flaccid  or 
if  the  pushing  of  the  instrument  through  the  cervical  canal 
requires  some  deg'ree  of  pressure,  the  uterus  bends  sharply 
and  the  instrument  catches  in  this  and  punctures  the  wall. 

If  chronic  cervicitis  is  present,  it  inevitably  causes  scle^ 
rosis  of  the  annular  mucous  folds  of  the  cervix,  and  the  hy- 
pertrophy of  the  sclerotic  areas  presses  across  against  the 
opposite  side  of  the  cervical  canal,  bending  it  out  of  its 
course  and  narrowing  its  lumen.  The  sharp  bendings  of  the 
canal,  with  the  intruding  sclerotic  and  hypertrophied  masses, 
so  impede  the  passage  of  the  instrument  that  once  it  has 
entered  the  uterine  cavity,  the  resistance  of  the  uterine  wall 
is  not  clearly  recognizable  if  the  instrument  is  pushed  into 
or  through  it.  When  using  the  dilators,  therefore,  the  ad- 
vancement of  the  instrument  should  cease  w^hen  the  uterine 
cavity  is  reached.  The  length  of  the  cervix,  if  doubt  arises, 
may  be  learned  by  rectal  palpation.  The  same  means  may 
be  used  to  learn  when  the  dilator  has  passed  the  cervical 
canal.  In  all  cases  where  the  cervical  canal  is  not  freely 
open  and  sufficiently  direct  to  permit  the  easy  passage  of  the 
uterine  catheter,  it  is  prudent  and  advisable  to  use  first  the 
uterine  dilator.  I  have  found  the  Palmer  uterine  dilator  of 
the  human  gynecologist,  modified  as  shown  in  Fig.  39,  the 
best  instrument  for  this  purpose.  It  is  small  and  the  curva- 
ture of  its  blades  corresponds  fairly  well  with  the  average 


io6  Diseases  of  the  Genital  Orgaiis 

bendings  of  the  cervical  canal.  The  dilation  of  the  cervical 
canal  is  essentially  alike  for  diagnosis  and  therapy.  When 
the  canal  is  very  narrow  and  is  pressed  upon  by  sclerotic  en- 
largements in  the  mucosa,  the  passage  of  a  catheter  suffi- 
ciently large  to  permit  of  satisfactory  douching  either  for 
diagnosis  or  treatment,  is  both  difficult  and  dangerous.  Even 
if  it  is  accomplished,  the  cervical  disease  cannot  be  satisfac- 
torily handled  until  the  canal  has  been  freely  dilated. 

Once  the  instrument  has  reached  the  os  uteri  internum, 
the  gradual  dilation  of  the  canal  should  be  undertaken  by 
forcing  the  forceps  jaws  apart  with  the  thumb  screw.  The 
opening  of  the  jaws  should  be  very  gradual  and  prudence 
used  in  the  amount  of  force  applied.  In  heifers  especially 
which  have  suffered  severely  from  cervicitis,  and  there  is 
consequently  well  advanced  sclerosis,  the  tissues  may  fail  to 
relax  under  the  strain  but  rupture  instead.  The  instrument 
must  on  no  account  be  pushed  toward  the  uterus  while  the 
jaws  are  opened  as  there  is  great  danger  of  pushing  them 
through  the  uterine  or  cervical  wall.  There  is  great  danger, 
while  dilation  is  proceeding,  if  the  operator  pushes  toward 
the  uterus  when  the  patient  strains.  At  such  times  the  in- 
strument must  be  permitted  to  move  backward  with  the  cer- 
vix. The  process  of  dilation  should  be  continued  for  a  suffi- 
cient period  of  time  to  render  the  cervical  canal  of  sufficient 
size  to  admit  of  the  ready  passage  of  a  small  uterine  cathe- 
ter, uterine  dressing  forceps,  or  other  desired  instruments. 
Once  the  forceps  blades  are  forced  apart,  the  operator  may 
cautiously  exert  traction  upon  them,  eventually  drawing  the 
forceps  out  with  the  jaws  widely  separated.  This  presses 
the  free  borders  of  the  annular  mucous  folds  outward 
against  the  cervical  walls  and  tends  to  cause  them  to  remain 
out  of  the  way  temporarily  while  the  uterine  catheter  may 
be  introduced.  It  is  best  in  case  of  a  very  narrow  cervical 
canal  to  open  and  close  the  dilator  alternately  and  while 
closed  to  revolve  the  instrument  in  varying  degrees  so  that 
the  direct  pressure  of  the  blades  shall  be  exerted  on  all  parts 
of  the  cervical  walls.  With  patience,  the  pale  muscles  of  the 
cervix  gradually  become  exhausted  and  finally  the  canal  at- 


Exa  in  in  a  tio  7i  of  th  c  Cervica  I  Canal  107 

tains  a  sufficient  lumen  so  that  a  moderately  large  uterine 
catheter  may  be  passed  through  it  without  difficulty  or  dan- 
ger. This  having  been  attained,  catheterization  may  be  un- 
dertaken. The  catheter  used  should  always  be  of  as  large 
caliber  as  the  cervical  canal  will  readily  and  safely  admit, 
because  the  greater  the  caliber  of  the  catheter,  the  more  effi- 
cient the  douching  of  the  uterus.  If  the  operator  has  care- 
fully observed  the  windings  of  the  cervical  canal  while  using 
the  dilator,  he  will  better  understand  the  direction  which 
the  catheter  must  take.  The  catheter  selected  as  of  proper 
dimensions  should  be  introduced  into  the  cervical  canal  very 
gently  and  advanced  with  great  care.  Force  is  at  all  times 
to  be  avoided.  If  the  catheter  will  not  pass  without  force, 
it  should  be  laid  aside  and  the  dilators  again  used  and  this 
plan  repeated  until  the  dilation  suffices. 

The  uterine  catheter,  like  the  dilator,  should  not  be 
pressed  deeply  into  the  uterus  but  merely  far  enough  that 
the  fenestrum  of  the  instrument  is  free  in  the  cavity  of  the 
uterus  so  that  douching  will  be  practicable.  At  the  moment 
of  entering  the  uterus,  the  concave  side  of  the  catheter 
should  be  directed  ventralward  and  so  maintained  through- 
out douching.  Occasionally  blood  escapes  through  the  cathe- 
ter, indicating  mechanical  injury  to  the  uterine  mucosa,  and 
this  should  cause  the  operator  to  beware  of  impending 
trouble.  Once  I  misjudged  the  length  of  the  cervical  canal, 
pushed  the  uterine  catheter  too  far,  and  caused  an  extensive 
antero-posterior  laceration  in  the  uterine  mucosa  along  the 
dorsal  surface  with  copious  hemorrhage.  I  had  been  careful 
and  could  not  identify  the  character  of  the  injury  and  it  was 
only  later  when  she  was  slaughtered  as  a  tuberculin  reactor, 
that  the  cicatrix  in  the  organ  revealed  the  character  of  the 
lesion.  In  this  instance  the  blood  did  not  escape  through  the 
catheter  but  was  forced  out  after  the  withdrawal  of  the  in- 
strument. The  cow  suffered  greatly,  kicked  at  her  belly,  lay 
down  and  rose  frequently,  trembled,  sweat,  and  breathed 
rapidly.  The  hemorrhage  was  not  of  sufficient  volume  to 
cause  the  symptoms  directly  from  the  loss  of  blood  nor  could 
the  lesion  in  itself  cause  so  much  pain.  Apparently  the  dis- 
tress was  due  to  uterine  colic,  that  is,  the  small,  empty 


io8  Diseases  of  the  Geyiital  Organs 

uterus,  not  recently  gravid,  rapidly  filled  with  blood  and  the 
cervix  being  firm,  it  could  not  readily  escape  but,  being  re- 
tained, aroused  violent  contractions  like  those  seen  when  a 
volume  of  fluid  is  inadvertently  left  behind  when  douching. 
The  difficulty  passed  in  an  hour  or  two  and  she  continued  ap- 
parently well.  Whenever  there  is  any  question  as  to  the 
course  of  the  catheter  or  other  instrument,  the  operator 
should  cautiously  palpate  per  rectum  and  determine  if  all  is 
well. 

Not  rarely,  when  the  catheter  enters  the  uterine  cavity 
there  is  a  sudden  inrush  of  air  by  which  the  uterus  becomes 
greatly  ballooned,  as  has  already  been  noted  of  the  vagina 
and  rectum  under  similar  conditions.  The  inflation  of  the 
uterus  sometimes  proves  annoying.  It  is  difficult  and  some- 
times impssible  to  douche  the  inflated  organ  until  a  very 
large  amount  of  fluid  has  been  introduced  because  the  liquid 
drops  downward  and  forward  to  the  ovarian  end  of  the 
uterus  while  the  air  occupies  the  cervical  end  of  the  cavity 
which  is  highest.  If  left  in  the  uterus,  it  may  cause  colic.  It 
can  be  pressed  out  through  the  catheter  by  careful  rectal 
manipulation.  (Gynecologists  apparently  encounter  the 
same  condition  in  woman  and  some  writers  describe  it  as 
"acute  dilation  of  the  uterus".) 

When  the  catheter  is  accidentally  pushed  through  the  uter- 
ine wall  and  the  peritoneal  cavity  is  entered,  there  is  gener- 
ally an  inrush  of  air  through  the  instrument.  In  this  one 
regard  the  inflation  of  the  uterine  cavity  through  the  cathe- 
ter and  the  flow  of  air  into  the  peritoneal  cavity  are  much 
alike  but  in  general  the  rate  and  volume  of  air  drawn  in  are 
greater  in  the  latter. 

When  an  antiseptic  fluid,  like  a  two  per  cent  Lugol's  solu- 
tion, is  introduced  into  the  peritoneal  cavity  through  the 
catheter,  it  immediately  causes  marked  depression  and  un- 
easiness, with  rapid  breathing,  trembling,  sometimes  lying 
down,  and  other  evidences  of  distress.  The  cow  tenses  her 
abdominal  walls,  arches  her  back  and  visually  appears  to 
be  bloated.  If  the  uterus  is  clean  and  little  or  no  infection 
is  forced  into  the  peritoneal  cavity,  lymph  is  soon  thrown 


Examination  of  the  Cervical  Canal  109 

out,  which  dilutes  the  Lugol's  solution.  Rapid  absorption  may 
follow  and  iodism  result.  The  distress  from  the  introduc- 
tion of  Lugol's  solution  into  the  peritoneal  cavity  is  of  short 
duration  and  within  one-half  to  two  hours  she  seems  as  well 
as  before.  The  uterine  wound  heals  promptly  and  little  or 
no  harm  follows.  When  coal  tar  disinfectants  and  others  of 
a  highly  irritant  character,  especially  those  not  freely  solu- 
ble in  the  lymph,  are  introduced,  the  irritation  is  more  se- 
vere and  prolonged,  with  great  danger  of  a  severe  peritoni- 
tis with  serious  peril  to  life.  If  death  is  avoided,  the  peri- 
tonitis may  lead  to  extensive  adhesions  destroying  the  value 
of  the  patient.  Some  veterinarians  have  counseled  the  use 
of  bicarbonate  or  chloride  of  sodium  solution  as  a  douche, 
but  if  this  or  other  neutral  fluid  is  used  and  a  puncture  of 
the  uterus  occurs  with  the  fluids  entering  the  peritoneal 
cavity,  the  danger  is  extreme  because  usually  infection  is 
borne  from  the  uterus  and  sets  up  a  violent  and  fatal  peri- 
tonitis. In  Fig.  43,  is  shown  a  uterus  punctured  by  pushing 
a  catheter  much  too  far,  a  fatal  peritonitis  following  douch- 
ing with,  it  was  claimed,  soda  bicarbonate  solution.  Whether 
the  infection  was  due  to  a  dirty  catheter,  whether  it  bore 
infection  from  the  cervix  or  uterus  into  the  peritoneal  cav- 
ity, or  whether  the  soda  solution  itself  was  septic,  does  not 
materially  alter  the  case.  No  antiseptic  was  present  to  de- 
stroy the  infection. 

When  pus  is  present  in  the  uterus  in  large  quantities  and 
of  high  virulence,  as  is  most  frequently  seen  in  the  puerperal 
animal,  a  gross  rupture  of  the  organ  is  followed  at  once  by 
very  alarming  symptoms  which  frequently  prove  fatal 
within  two  or  three  hours.  The  shock  is  especially  pro- 
found when  it  is  attempted  to  douche  a  large  paretic  uterus 
containing  a  great  volume  of  virulent  material  and  a  great 
amount  of  water  is  introduced  to  add  to  the  mass  of  liquid. 
A  large  rupture  of  the  uterus  releasing  the  great  mass  of 
infected  liquid,  which  immediately  reaches  the  total  peri- 
toneal surface,  produces  prompt  collapse.  The  abdominal 
walls  at  once  become  tense  and  fixed,  the  breathing  being 
thoracic,  rapid  and  shallow.    The  patient  appears  tympani- 


I  lo  Diseases  of  the  Genital  Organs 

tic,  shows  intense  suffering  and,  as  a  rule,  quickly  succumbs. 
Some  of  them,  however,  after  remaining  in  an  extremely 
critical  state  for  some  days  slowly  improve  but  as  a  rule 
never  regain  condition  and  must  eventually  be  destroyed  as 
useless. 

Consequently  in  the  instrumental  examination  of  the 
uterus,  as  in  that  of  the  cervix,  ample  care  is  always  to  be 
taken  to  avoid  rupture.  Such  care  must  be  based  upon  ac- 
curate anatomic  knowledge,  surgical  skill,  patience,  and  the 
application  of  the  invariable  rule  that,  i/  the  instrument  can- 
not be  passed  ivithout  the  use  of  force,  the  effort  must  he 
suspended.  The  cervical  canal  dilates  during  estrum,  at 
which  time  an  instrument  may  far  more  readily  be  passed 
into  the  uterus.  If  the  operator  desires,  he  may  dislodge  the 
corpus  luteum  and  return  after  three  days  with  reasonable 
assurance  that  he  will  find  the  patient  in  estrum  and  her 
cervical  canal  dilated.  If  he  will  then  use  the  dilators  pru- 
dently, he  will  leave  the  canal  dilated  and  the  angles  modified 
in  a  manner  to  render  catheterization  of  the  uterus  less  diffi- 
cult if  again  undertaken  in  a  few  days.  Aside  from  the  diag- 
nosis of  estrum  and  the  advantage  of  the  dilated  cervix  fa- 
cilitating the  catheterization  of  the  uterus,  estrum  is  a  very 
poor  time  to  examine  the  genitalia,  because  vagina,  cervix, 
and  uterus  are  so  filled  with  mucus,  and  the  uterus  so  en- 
larged and  engorged  that  many  pathologic  conditions  may 
be  so  completely  screened  as  to  be  wholly  unrecognizable. 

When  the  catheter  has  entered  the  uterine  cavity,  the  ex- 
amination is  to  be  completed  by  douching.  For  this  purpose 
I  prefer  a  one  to  two  per  cent.  Lugol's  solution,  rather  than 
sterile  salt  solution  or  other  neutral  liquid,  because,  in  my 
judgment,  the  disinfectant  renders  the  operation  safer,  es- 
pecially when  any  minor  injury  to  the  cervical  or  uterine 
mucosa  has  occurred.  The  faintly  brownish  and  clear  fluid 
serves  to  form  a  contrast  with  pus  or  muco-pus  rendering 
them  more  apparent.  Physiologically  the  douche  should  re- 
turn clear  and  uniform  except  that  in  estrum  there  should 
first  escape  some  clear  mucus,  and  during  the  one  or  two 
days  following  estrum,  some  partly  clotted  menstrual  blood. 


The  Diagnosis  of  Estriun  in 

Admitting  fully  the  dangers  incurred  in  the  manual  and 
instrumental  examination  of  the  genital  organs  of  mares 
and  cows,  it  nevertheless  remains  that  (1)  such  examina- 
tion is  not  in  the  ordinary  sense  necessarily  dangerous  and 
(2)  the  examination  is  absolutely  essential  to  a  safe  diag- 
nosis. Accidental  injuries  to  the  genital  organs  of  cows 
and  mares  in  the  course  of  examination  are  happily  rare  in 
the  hands  of  competent  veterinarians.  At  present  there  is 
much  activity  in  the  handling  of  sterility  in  cows  and  many 
veterinarians,  some  of  whom  have  always  blundered  at  each 
critical  step,  have  plunged  headlong  into  this  field  with 
neither  the  chart  of  anatomical  knowledge  nor  the  compass 
of  ordinary  prudence.  Naturally  they  make  many  and  seri- 
ous errors  and  bring  undeserved  discredit  upon  one  of  the 
most  valued  fields  of  veterinary  service.  The  veterinarian 
who  will  not  give  long  and  conscientious  study  to  the  sub- 
ject, has  no  moral  right  to  attempt  the  work. 

The  physical  examination  of  the  genitalia  not  only  serves 
the  necessary  purpose  of  diagnosing  disease  but  also  serves 
to  identify  estrum,  the  period  of  sexual  rest  between  estrual 
periods,  and  pregnancy. 

C.  The  Diagnosis  of  Estrum 

The  diagnosis  of  estrum  is  of  great  practical  importance 
because  in  numerous  instances  the  ordinary  clinical  signs 
fail  unless  the  veterinarian  is  able  to  apply  a  more  technical 
and  accurate  method  of  determination.  Without  technical 
examination,  the  breeder  may  fail  to  recognize  the  condition 
and  hence  omit  breeding.  The  cow  or  heifer  commonly  re- 
veals the  presence  of  estrum  by  bellowing  and  restlessness, 
whether  in  stable  or  field.  In  the  field  or  paddock  with  other 
cattle,  the  animal  in  estrum  repeatedly  mounts  other  cattle 
or  stands  to  be  mounted  by  them.  Often  there  is  a  dis- 
charge of  thin  mucus  from  the  vulva.  In  many  cases  cattle 
are  not  out  in  paddock  or  field  daily  so  that  the  tendency  to 
mount  other  cattle  is  not  apparent.  Some  individuals  show 
little  excitement  and  do  not  bellow  enough  to  attract  atten- 
tion in  the  stable.    Even  when  turned  daily  into  the  paddock 


112  Diseases  of  the  Ge)utal  Orga?is 

or  field,  as  is  commonly  done  in  winter  for  only  a  brief  in- 
terval, a  cow  may  pass  through  her  active  estrual  period 
during  the  interval  between  two  periods  in  the  paddock. 
Not  infrequently  such  unrecognized  estrual  periods  result 
in  expensive  delay  in  breeding. 

The  chief  evidences  of  estrum  revealed  upon  physical  ex- 
amination are : 

(1)  The  vagina  contains  much  thin,  lubricant,  clear  mu- 
cus. In  metritis,  cervicitis,  and  vaginitis  the  mucus  may 
contain  floccules  of  muco-pus.  The  flow  of  the  mucus  of  es- 
trum appears  in  the  vagina  twenty-four  hours  or  more  prior 
to  the  establishment  of  sexual  desire  and  terminates  about 
twenty-four  hours  after  the  cessation  of  estrum.  If  fertiliza- 
tion fails,  the  discharge  of  estrual  mucus  is  displaced  by  the 
menstrual  flow. 

(2)  The  cervix  is  relaxed  and  the  canal  more  dilated  and 
dilatable  than  in  the  inter-estrual  period  of  rest. 

(3)  The  uterus  is  engorged.  Prior  to  the  full  develop- 
ment of  estrum,  the  uterus  may  be  normal  to  the  touch  at 
first,  but  under  palpation  becomes  engorged  or  erected. 
When  estrum  is  at  its  height,  the  engorgement  is  constant. 
The  diameter  of  the  engorged  uterus  of  estrum  is  increased 
about  one-half,  is  much  firmer  than  during  the  inter-estrual 
pause,  and  is  smooth,  even,  and  very  firm.  It  is  about  the 
same  size  as  the  pregnant  uterus  at  thirty  to  forty  days,  but 
is  distinguishable  by  its  firm,  engorged  character,  in  con- 
trast with  the  fluctuant,  tense  uterus  of  pregnancy.  It  is 
less  hard,  and  smaller  than  the  uterus  of  chronic  sclerotic 
metritis  with  destruction  of  the  uterine  mucosa. 

(4)  The  corpus  luteum  of  the  preceding  estrum  is  atro- 
phied to  about  one-half  its  ordinary  diameter,  or  about  three- 
eighths  of  an  inch. 

(5)  There  is  present,  generally  upon  the  opposite  ovary, 
a  mature  ovisac,  a  thin-walled  cyst  one-half  inch  or  a  trifle 
more  in  diameter.     (See  Figs.  22-25.) 

If  it  is  desired  to  breed  the  animal  during  the  existing  es- 
trum, the  examiner  needs  to  be  very  cautious  in  palpating 
the  ripe  ovisac  since  under  very  slight  pressure  it  ruptures, 


Tlie  Diag?iosis  of  Pregnancy  1 13 

the  ovum  escapes  into  the  peritoneal  cavity,  and  conception 
is  barred  for  that  estrual  period. 
Recent  estrum  is  recognized : 

(1)  By  menstrual  blood  in  the  vagina  or  the  soiling  of  the 
tail  and  buttocks  with  blood,  about  twenty-four  hours  after 
estrum  has  ceased ; 

(2)  By  engorgement  of  the  uterus  which  continues  during 
menstruation ; 

(3)  By  the  rapid  atrophy  of  the  corpus  luteum  of  the  pre- 
ceding estrum ; 

(4)  By  the  palpation  of  the  crater  of  the  ruptured  ovisac. 
The  diagnosis  of  estrum  may  be  rendered  more  certain  by 

concentrating  the  observations  to  a  brief  period.  Thus, 
when  the  soiling  of  the  tail  and  buttocks  with  menstrual 
blood  is  observed,  if  the  breeder  will  watch  the  animal  closely 
from  the  eighteenth  to  the  twentieth  day  thereafter  and 
take  occasion  to  place  the  cow  in  paddock  or  field  with  the 
bull  or  other  cattle,  estrum  will  in  all  probability  be  recog- 
nized. The  time  during  which  close  watch  is  to  be  kept  may 
be  even  further  concentrated  by  dislodging  the  corpus  lu- 
teum when  it  is  well  formed  and  watching  the  patient  from 
the  third  to  the  fifth  day  thereafter. 

D.  The  Diagnosis  of  Pregnancy 

The  accurate  diagnosis  of  pregnancy  in  the  cow  is  a  fun- 
damental necessity  in  the  handling  of  diseases  of  the  genital 
organs.  The  gravest  and  most  embarrassing  errors  made 
in  dealing  with  the  genital  organs  are  the  failure  to  diag- 
nose an  existing  pregnancy  and  the  erroneous  diagnosis  of 
pregnancy  when  the  animal  is  sterile.  The  failure  to  recog- 
nize an  existing  pregnancy  frequently  leads  to  instrumental 
abortion  or  to  the  slaughter  of  a  valuable  pregnant  animal 
which  is  wrongly  believed  to  be  sterile.  The  diagnosis  of 
pregnancy,  when  the  animal  is  sterile,  leads  often  to  months 
of  expensive  delay  in  breeding.  The  examination  for  preg- 
nancy of  valuable  animals  which  are  for  sale  is  gradually 
assuming  scientific  and  economic  importance.  In  some 
large  herds  placed  in  dispersal  sales,  all  the  cattle  are  ex- 
8 


114  Diseases  of  the  Genital  Orgatis 

amined  in  detail  and  certificates  of  pregnancy  or  non-preg- 
nancy by  a  skilled  veterinarian  issued  for  each  female. 
Eventually,  probably  before  most  veterinary  practitioners 
are  ready  to  render  highly  efficient  service,  buyers  of  ex- 
pensive breeding  cattle  will  demand  reliable  veterinary  ex- 
aminations as  to  sexual  soundness.  In  the  female  assumed 
to  be  pregnant,  the  prudent  buyer  will  place  first  reliance 
upon  the  judgment  of  an  expert  veterinarian. 

The  signs  of  pregnancy  are  many.  Each  has  its  value 
and  each  is  subject  to  certain  limitations : 

1.    The  Failure  of  Menstruation  After  Copulation 

When  conception  follows  coition,  estrum  is  rarely  followed 
by  menstruation.  If  menstruation  follows  coition  after  24 
to  48  hours,  the  cow  is  probably  non-pregnant. 

2.    The  Cessation  of  Estrum 

If  a  cow  or  heifer  has  been  regular  in  her  estrual  periods, 
and  estrum  fails  to  recur  at  the  normal  date,  the  animal  is 
quite  probably  pregnant.  The  probability  is  accentuated  if 
menstruation  following  coitus  failed.  The  sign  is  of  little 
value  in  irregular  estrum.  The  estrual  period  may  be  com- 
paratively short  or  long,  but  in  order  to  be  of  value  in  judg- 
ing conception,  the  periods  need  to  be  alike.  That  is,  one 
animal  may  have  an  estrual  cycle  of  eighteen,  and  another  of 
twenty-two,  days  but  an  animal  having  once  an  interval  of 
eighteen  days  and  at  another  time  a  cycle  of  twenty-two 
days  offers  suspicion  of  ovarian  disease.  The  failure  of  an 
estrual  period  in  such  an  animal  is  not  a  good  index  of  con- 
ception. In  healthy  cows  and  heifers  there  is  little  varia- 
tion in  the  estrual  cycle  in  the  individual ;  the  variation  rarely 
exceeds  twenty-four  hours.  It  is  important  alike  for  the 
breeder  and  the  veterinarian  that  accurate  records  be  kept 
for  each  heifer  and  cow. 

Estrum  does  not  always  cease  with  conception.  In  my 
judgment,  one  to  two  per  cent,  of  pregnant  cows  and  heifers 
show  estrum.  In  some  of  these,  the  estrum  recurs  at  vary- 
ing intervals  up  to  the  seventh  or  eighth  month,  but  as  a  rule 


The  Cessation  of  Est  nun  1 15 

it  ceases  to  recur  after  the  third  or  fourth  month  of  preg- 
nancy. Sometimes  the  recurrence  of  estrum  is  regular,  re- 
peating the  cycle  prevailing  in  the  individual  prior  to  con- 
ception, but  usually  the  cycle  is  irregular.  So  far  as  I  have 
observed,  the  estrum  of  pregnancy  is  not  followed  by  men- 
struation. In  fact,  menstruation  is  not  ordinarily  possible, 
owing  to  the  uterine  seal  blocking  the  cervical  canal  and 
preventing  exit. 

Estrum  not  infrequently  fails  to  recur  after  copulation 
although  conception  did  not  follow.  Sometimes  the  failure 
of  estrum  to  recur  is  due  to  retained  corpus  luteum,  some- 
times pyometra  (without  discharge)  follows  estrum  and 
coitus,  inhibits  estrum  and  misleads  the  caretaker.  Poverty 
serves  to  prevent  alike  ovulation  and  estrum.  The  failure 
of  estrum  to  recur  in  non-pregnant,  and  the  recurrence  of 
estrum  in  pregnant  animals  render  it  clear  that  the  pres- 
ence or  absence  of  estrum  does  not  furnish  secure  ground 
for  diagnosis  relative  to  pregnancy.  The  evidence  must  be 
supported  by  other  facts  in  order  to  be  reliable. 

The  estrum  of  pregnancy  has  been  little  studied.  In  one 
case  which  I  had  the  good  fortune  to  examine  while  the  ani- 
mal was  in  estrum,  the  corpus  luteum  of  pregnancy  had 
atrophied  and  a  ripe  ovisac  was  present  on  the  non-gravid 
side.  I  think  it  more  than  possible  that  the  estrum  of  preg- 
nancy is  generally  due  to  this  cause.  The  corpus  luteum  of 
pregnancy,  for  some  unknown  reason,  atrophies,  loses  its 
inhibitory  power  upon  the  maturation  of  ovisacs,  and  es- 
trum, so  far  as  the  ovaries  are  concerned,  appears  in  the  or- 
dinary manner. 

It  is  of  scientific  interest  to  note  here  also  that  the  estrum 
of  pregnancy,  with  the  atrophy  of  the  corpus  luteum  and  the 
ripening  of  an  ovisac  upon  the  opposite  ovary,  is  the  possible 
foundation  for  numerous  errors  regarding  the  migration  of 
the  ovum.  It  has  been  claimed  that  finding  a  fetus  in  one 
horn  and  the  corpus  luteum  in  the  alternate  ovary  is  proof 
of  the  migration  of  the  ovum,  and  that  the  fertilized  ovum 
has  dropped  into  the  peritoneal  cavity,  been  transported  to 
the  pavilion  of  the  opposite  oviduct  and  penetrated  it,  or  that 


1 16  Diseases  of  the  Genital  Organs 

the  ovum  has  passed  down  the  horn  corresponding  to  the 
ovary  from  which  it  emanated,  thence  across  the  uterine 
body  cavity  and  up  the  opposite  horn.  My  observation 
makes  it  perfectly  clear  that  the  alternating  of  the  fetus  and 
the  corpus  luteum  is  not  proof  of  migration. 

The  abnormality  of  estrum  (and  coitus)  appears  to  have 
no  serious  peril  for  either  the  pregnant  animal  or  the  fetus. 
It  is  clear  evidence  of  a  pathologic  state,  but  many  cows  and 
heifers  show  frequent  estrum  and  copulate  freely  without 
showing  any  marked  tendency  to  abort  or  for  the  pregnancy 
to  terminate  unfavorably  in  any  marked  respect.  Some  of 
them  abort,  it  is  true,  but  I  have  been  unable  to  learn  that 
their  tendency  to  abort  is  greater  than  in  pregnant  cows 
which  do  not  show  estrum.  A  few  cases  have  occurred  under 
conditions  which  have  led  some  to  believe  that  coitus  caused 
abortion  almost  immediately.  Thus  I  recall  one  cow  which 
came  in  estrum  in  the  sixth  month  of  pregnancy,  copulated, 
and  the  next  day  aborted.  In  other  instances,  a  cow  carry- 
ing a  desiccated  fetus  develops  estrum,  copulates,  and  a 
few  hours  later  expels  the  mummy.  I  think  it  reasonably 
certain  that  the  facts  have  been  misinterpreted,  and  that, 
instead  of  the  coitus  causing  the  expulsion  of  the  fetus,  the 
corpus  luteum  has  atrophied,  an  ovisac  has  ripened,  estrum 
and  coitus  have  occurred,  and  because  of  the  atrophy  of  the 
corpus  luteum,  not  because  of  coitus,  the  uterus  contracts 
and  expels  the  fetus.  That  is,  instead  of  the  estrum  and 
copulation  causing  the  abortion,  the  disease  has  brought 
about  the  changes  in  the  ovary,  the  estrum,  the  copulation, 
and  the  expulsion  of  the  fetus.  The  problem  merits  further 
study. 

Menstruation  following  estrum  in  pregnancy  is  incom- 
patible with  the  life  of  the  fetus,  because  the  menstrual 
blood  consists  of  a  hemorrhage  emanating  from  the  pla- 
cental areas  (cotyledons)  of  the  uterus.  Menstruation 
would,  therefore,  result  first  of  all  in  a  hemorrhage  between 
the  maternal  and  fetal  structures  which  would  force  the  two 
structures  asunder   (compare  "Desiccation  of  the  Fetus"). 


The   Uterine  Seal 


117 


3.    The  Uterine  Seal 

If  the  vagina  and  cervix  are  healthy,  the  cervical  canal  is 
well  sealed  at  from  thirty  to  forty  days  after  conception  and 
it  may  be  felt  clearly  upon  palpation  per  vaginam.  In  order 
to  recognize  this,  the  finger  tip  must  be  pressed  carefully 
and  gently  against  the  external  os  uteri  and  then  cautiously 
withdrawn ;  if  the  seal  is  present,  it  is  readily  revealed  by 
its  adhesiveness.  In  the  earlier  stages  the  seal  is  very  small, 
only  one-eighth  to  one-fourth  inch  across,  and  does  not  pro- 


FiG.  44— The  Uterine  Seal  in  Early  Pregnancy  in  Heifer. 
F,  Embryo  ^i  inch  long  in  the  embryonic  sac  ;    5.  uterine  seal  in  cross  sec- 
tion ;  O,  ovary  with  corpus  lutem  of  pres^nancy  ;  A,  uterine  seal 
protruding  from  the  vaginal  end  of  the  cervix. 

ject  into  the  vagina.  It  is  distinct,  however,  and  adheres 
clearly  to  the  finger  tips.  It  continues  to  grow  and  soon 
bulges  out  into  the  vagina.  The  uterine  seal  involves  the 
cervical  mucosa  only.  As  stated  earlier,  however,  the  annu- 
lar folds  of  the  cervical  mucosa  push  out  into  the  vagina  in 
the  cow  which  has  calved  and  especially  when  she  has  suf- 
fered from  cervicitis.  The  protruding  portions  of  the  cervical 


1 1 8  Diseases  of  tlie  Genital  Organs 

mucosa  function  as  though  they  remained  in  the  canal  so 
that  in  such  animals  the  uterine  seal  proceeds  from,  and 
covers  over,  the  mucosa  protruding  into  the  vagina.  In  the 
mare,  in  advanced  pregnancy,  the  uterine  seal  projects  into 


Fig.  45— The  Uterine  Seal  of  an  Adult  Cow  in  Advanced  Pregnancy. 

Cross  seciions  through  the  cervix  at  various  points.     The  lartjer 

seals  are  near  the  vaginal  end. 

the  vagina  as  an  adhesive,  somewhat  cylindrical  body,  one, 
two,  or  more  inches  in  length.  Its  size  and  protrusion  in- 
crease until  just  before  the  close  of  pregnancy,  when  it 
softens,  changes  to  lubricant  mucus,  and  strings  from  the 
vulva.  During  pregnancy  the  mucus  secreted  by  the  vagina 
becomes  exceedingly  sticky,  having  much  the  same  charac- 
ter as  the  uterine  .  eal. 


The   Uterine  Seal 


19 


Sometimes  a  false  uterine  seal  forms,  as  a  result  of  dis- 
ease, as  in  retained  corpus  luteum  and  in  cervicitis.  The 
uterine  seal  persists  when  the  fetus  dies  and  desiccates,  and 
when  the  embryo  dies  and  the  embryonic  sac  remains  to  con- 
stitute a  *'mole". 

The  uterine  seal  may  fail  to  form  or  it  may  break  down 
when  the  cervix  is  badly  diseased  and  abortion  is  imminent. 
Consequently  the  presence  of  the  typical  seal  not  only  gives 
reliable  evidence  of  pregnancy,  but  adds  to  that  a  certain 
feeling  of  security,  suggesting  not  only  that  the  animal  is 


Fig.  45a — The  Uterine  Seal  in  Longitudinal  Section.     Cow. 

/,  Os  uteri  externum  ;  2,  os  uteri  internuni ;  3,  base  of  second  annular  cervi- 
cal fold  ;  4,  uterine  seal  extending  throughout  the  length  of  the  canal. 

pregnant,  but  perhaps  safely  so.  In  severe  purulent  vagini- 
tis or  purulent  cervicitis  of  the  vaginal  portion,  the  uterine 
seal  may  exist  in  the  uterine  end  of  the  cervical  canal  and  be 
displaced  by  pus  in  the  vaginal  portion.  The  seal  may  then 
be  recognized  by  palpating  it  with  a  metallic  sound,  uterine 
catheter,  or  dilator  introduced  cautiously  along  the  cervical 
canal.  While  the  uterine  seal  is  one  of  the  most  important 
evidences  of  pregnancy,  it  has  its  limitations  in  diagnosis 
and,  like  most  signs,  needs  to  be  considered  in  conjunction 
with  other  findings. 


I20  Diseases  of  the  Genital  Organs 

4.    The  Corpus  Luteum  of  Pregnancy 
(See  Fig.  26) 

Physiologically,  a  corpus  luteum  develops  after  each  es- 
trum,  and  is  of  the  same  form,  size,  and  consistency,  whether 
the  animal  be  pregnant  or  not.  In  sterility,  however,  the 
corpus  luteum  is  one  of  the  most  common  sufferers  from 
pathologic  changes.  The  bovine  corpus  luteum  of  preg- 
nancy is  normally  five-eighths  to  three-quarters  of  an  inch 
in  diameter,  somewhat  oval  in  form,  usually  even  in  con- 
tour, and  firm  in  consistency.  Forming,  as  it  does,  within 
the  crater  left  behind  when  the  ovisac  ruptures,  it  is  at  first 
naked.  That  is,  it  is  not  covered  by  the  tunic  of  the  ovary 
and  it  protrudes  somewhat  beyond  the  surface  of  the  gland. 
If  the  animal  conceives,  the  tunic  of  the  ovary  soon  draws 
over  the  surface  of  the  yellow  body  and  leaves  it  smooth 
and  firm.  The  wound  is  healed.  Sometimes  a  considerable 
projection  remains,  even  though  the  tunic  has  drawn  over 
the  yellow  body.  In  sterility,  however,  the  wound  in  the 
ovisac  frequently  fails  to  heal  and  the  yellow  body  remains 
for  a  long  period  of  time  protruding  and  naked.  The  pro- 
truding dome  feels  soft  upon  palpation,  like  the  exuberant 
granulation  of  an  unhealthy  ulcer.  The  corpus  luteum  of 
sterility  frequently  undergoes  cystic  degeneration  in  its 
center.  It  becomes  soft  and  more  or  less  fluctuant,  accord- 
ing to  the  degree  of  degeneration.  Finally,  as  the  degenera- 
tion extends,  the  lutein  tissue  disappears  and  a  cyst  remains. 
When  one  can  recognize  these  conditions  in  the  ovary,  he 
can  with  very  rare  exceptions  rest  assured  that  pregnancy 
has  not  occurred  through  fertilization  of  the  ovum  which 
was  discharged  from  the  ovisac  in  which  the  diseased  yellow 
body  develops.  He  must  not  be  deceived,  however,  because 
of  the  presence  of  a  cyst  or  cysts  in  an  ovary.  The  typical 
corpus  luteum  of  pregnancy  almost  always  exists  in  a  preg- 
nant animal,  but  cysts  may  co-exist.  Accordingly,  while  the 
absence  of  a  corpus  luteum  of  a  normal  type  is  fairly  con- 
clusive evidence  that  the  animal  is  not  pregnant,  the  co- 
existence of  a  large  cyst  in  the  same  or  other  ovary  is  not 
final  proof,  though  it  is  strong  evidence  that  the  animal  is 


The  Corpus  Liiteum  of  Pregnancy  121 

non-pregnant.  When  a  typical  corpus  luteum  of  pregnancy 
is  present  and  other  findings  are  in  accord,  the  evidence  it 
affords  is  of  the  greatest  possible  value.  Amongst  thousands 
of  ovaries  which  I  have  examined,  I  have  seen  but  one  cor- 
pus luteum  of  pregnancy  which  departed  markedly  in  volume 
from  the  normal.  The  one  exception  was  more  than  one  inch 
in  diameter.  In  cows  which,  though  pregnant,  nevertheless 
show  estrum,  the  corpus  luteum  disappears,  at  least  some- 
times. Hence  a  cow  may  be  pregnant  and  no  corpus  luteum 
present. 

The  corpus  luteum  of  pregnancy  persists  throughout 
pregnancy  and  for  thirty  to  sixty  days  after  its  close.  The 
corpus  luteum  of  estrum  is  a  temporary  structure,  which  be- 
gins to  disappear  rapidly  at  about  eighteen  days  after  es- 
trum, so  that  at  the  average  period  of  twenty-one  days  it  has 
become  so  far  resorbed  that  it  no  longer  inhibits  the  matur- 
ing of  a  fresh  ovisac. 

It  is  at  this  period  that  the  corpus  luteum  becomes  of 
special  significance  in  the  diagnosis  of  very  early  pregnancy. 
If  estrum  has  been  regular  and  the  animal  is  not  pregnant, 
it  is  very  certain  that  at  about  twenty-one  days  the  animal 
will  again  be  in  estrum  and  that  the  corpus  luteum  of  the 
previous  estrum  will  have  decreased  to  a  small  size.  At  the 
same  time,  if  estrum  is  near,  the  uterus  is  engorged,  the 
cervical  canal  is  dilated,  and  the  vagina  contains  the  lubri- 
cant mucus  of  estrum.  Hence,  if  the  practitioner  examines 
a  cow  at  about  eighteen  to  twenty-one  days  after  breeding, 
if  she  is  pregnant,  there  is  almost  invariably  a  typical  corpus 
luteum ;  if  she  is  not  pregnant,  the  corpus  luteum  is  definitely 
atrophied.  This  is  one  of  the  best  times  for  making  a  diag- 
nosis, and  a  highly  important  date,  because  if  the  animal  is 
not  pregnant,  immediate  measures  may  be  taken,  such  as 
disinfecting  the  uterine  cavity,  preparatory  to  breeding 
when  the  approaching  estrum  has  become  established. 

5.    The  Uterine  Arteries 

The  uterine  arteries  afford  definite  evidences  of  preg- 
nancy.   As  soon  as  the  fertilized  ovum  has  become  implanted 


122  Diseases  of  the  Genital  Organs 

in  the  uterus,  all  vessels  leading  to  that  organ  awaken  to  a 
wholly  new  activity.  There  are  three  pairs  of  arteries  con- 
cerned, the  utero-ovarian,  the  uterine,  and  the  vaginal.  In 
the  healthy  non-pregnant  cow  or  mare  each  of  these  is 
clearly  palpable  per  rectum,  approximately  one-eighth  inch 
in  diameter  and,  being  but  lightly  covered,  fields  a  clear, 
though  not  strong,  pulsation. 

The  utero-ovarian  artery,  analogue  of  the  chief  artery  of 
the  testicle  in  the  male,  arises  from  the  aorta  near  the  ori- 
gin of  the  small  mesenteric,  and,  passing  downward,  back- 
ward and  inward  between  the  peritoneal  layers  of  the  broad 
ligament,  divides  near  the  ovary  into  two  branches,  one  go- 
ing to  the  ovary,  the  other  supplying  the  oviduct  and  the 
apex  of  the  uterine  horn.  Readily  palpable  in  the  non-gravid 
animal,  it  is  soon  dragged  so  far  forward  that  rectal  palpa- 
tion is  rendered  inconvenient.  The  two  other  pairs,  which 
are  readily  reached,  suffice  in  virtually  all  cases,  and  conse- 
quently the  utero-ovarian  artery  is  commonly  ignored.  Its 
palpation  becomes  of  great  importance  in  the  diagnosis  of 
ovarian  tumors. 

The  middle  or  chief  uterine  artery  arises  usually  from 
the  posterior  aorta  near  its  division  into  the  iliacs,  or  from 
one  of  these,  and  is  easily  recognized  as  it  leaves  the  arterial 
trunk,  at  almost  right  angles,  in  the  region  of  the  anterior 
border  of  the  shaft  of  the  ilium.  It  curves  backward,  me- 
dianward,  and  finally,  in  the  form  of  an  arc,  forward,  to  dis- 
appear in  the  uterine  walls  at  or  near  to  the  base  of  the 
uterine  horn.  During  this  course  it  lies  between  the  two 
peritoneal  layers  of  the  broad  ligament  of  the  uterus,  is 
much  longer  than  the  broad  ligament  and  is  thrown  into  nu- 
merous S-shaped  coils.  It  is  readily  picked  lip  per  rectum 
and  palpated  in  the  non-pregnant  animal  and  in  all  stages 
of  pregnancy.  With  the  advent  of  pregnancy,  the  artery 
quickly  enlarges  and  the  pulsation  becomes  strong  and 
bounding.  The  arterial  stream  feels  as  if  impeded  and  there 
is  a  sensation  of  grating  not  encountered  in  other  healthy 
arteries.  The  artery  is  about  one-quarter  of  an  inch  in 
diameter  at  120  to  150  days ;  at  eight  months  it  is  one-half 


Palpation  of  the  Uterus  per  Rectum  123 

inch  or  over;  and  in  a  large  cow  closely  approaching  full 
term  it  may  be  nearly  three-quarters  inch,  full  and  bounding. 

The  posterior  uterine  or  vaginal  artery  is  given  off  from 
the  internal  pudic,  approximately  opposite  the  apex  of  the 
angle  between  the  sacro-sciatic  ligament  and  its  point  of  at- 
tachment to  the  sacrum,  and  passes  across  the  pelvic  cavity 
in  the  broad  ligament  of  the  vagina  to  the  vagina  and  cervix. 
In  the  healthy  non-pregnant  cow  it  is  almost  as  large  as  the 
main  uterine  artery.  It  is  easily  picked  up  per  rectum  and 
palpated.  Like  the  middle  uterine  artery,  it  enlarges  very 
rapidly  as  soon  as  pregnancy  is  established  but  attains  no 
such  great  dimensions  as  the  former.  It  reaches  ordinarily 
the  size  of  a  lead  pencil. 

The  examiner,  in  the  course  of  his  work,  should  acquaint 
himself  with  these  various  changes  by  studying  animals 
pregnant  for  a  known  period.  In  this  manner  he  becomes 
familiar  with  the  clinical  findings  and  is  able  to  reach  a 
closer  approximation  of  the  date  of  pregnancy  of  females 
whose  history  of  conception  is  wanting. 

6.    Palpation  of  the  Uterus  per  Rectum 

The  palpation  of  the  uterus  of  the  cow  and  mare  per  rec- 
tum affords  the  most  valuable  means  which  we  possess  for 
the  diagnosis  of  pregnancy.  After  conception  the  uterus 
undergoes  prompt  and  marked  changes  in  volume,  form, 
consistence,  and  location.  When  estrum  occurs,  there  is  a 
marked  engorgement.  The  organ  is  hard,  tense,  and  smooth. 
The  condition  is  most  notable  in  heifers.  If  conception  oc- 
curs, the  engorged,  undulatory  character  continues  for  a 
time  and  in  heifers  the  organ  remains  almost  static  in  size 
for  fifteen  to  twenty  days,  after  which  it  gradually  en- 
larges. In  cows  which  have  calved  previously,  these  symp- 
toms do  not  become  so  apparent  and  the  enlargement  is  not 
pronounced  until  thirty  to  sixty,  or  even  seventy  days.  Then 
the  uterus  becomes  larger,  most  markedly  in  the  gravid  horn. 

Owing  to  the  great  variations  of  the  size  of  the  uterus  in 
adult  cows  and  mares,  due  partly  to  individual  peculiarities 
and  partly  to  the  health  or  disease  of  the  organ,  one  has 


124  Diseases  of  the  Goiital  Organs 

sometimes  to  await  a  quite  definite  increase  in  volume  before 
this  becomes  of  distinct  value  in  determining  pregnancy. 
The  same  may  be  true  of  heifers  which  have  been  sterile  for 
a  long  period  and  in  which  the  uterus  has  undergone  en- 
largement because  of  chronic  endometritis. 

As  a  general  rule,  however,  heifers  which  have  conceived 
at  all  promptly  show  distinct  and  characteristic  enlargement 
of  the  uterus  within  twenty  to  thirty  days  after  conception, 
and  cows  at  any  time  from  thirty  to  sixty  or  seventy  days. 
The  enlargement  of  the  uterus  as  a  result  of  conception  is 
very  characteristic.  The  organ  may  be  enlarged  from  a 
great  variety  of  causes,  but  the  enlargement  due  to  other  in- 
fluences than  pregnancy  differs  materially  and  clearly  in  al- 
most every  case.  In  pregnancy  the  uterus  is  smooth  and  even 
in  outline,  firm,  tense,  and  fluctuating.  Except  in  case  of 
twin  pregnancy,  the  pregnant  horn  is  much  larger  than  the 
other  and  regularly  corresponds  with  the  corpus  luteum  of 
pregnancy.  While  the  corpus  luteum  is  regularly  palpable 
in  early  pregnancy  in  the  cow,  it  is  not  so  in  the  mare  be- 
cause it  is  hidden  deeply  in  the  hilus  of  her  ovary.  At  the 
region  of  the  internal  os  uteri,  the  superior  uterine  wall  of 
the  pregnant  cow  rises  up  suddenly  like  a  terrace  instead  of 
sloping  forward  gradually  as  is  observed  when  pus  or  lymph 
distends  the  organ.  The  firmness  of  the  uterine  wall  is  in 
marked  contrast  also  to  its  character  when  the  organ  is  dis- 
tended with  pus  or  lymph.  In  pregnancy  the  uterus  is  dis- 
tinctly firm  and  exhibits  to  the  touch  a  sense  of  vigor  and 
life.  When  lymph  distends  the  uterus,  the  walls  may  be  thin 
as  in  pregnancy  but  they  are  almost  always  soft  and  flaccid 
and  the  horns  are  usually  somewhat  equally  filled.  In  rare 
instances,  owing  to  compression  of  the  cervical  canal  due  to 
sclerotic  swellings  in  the  cervical  walls  associated  with  cer- 
vicitis, menstrual  debris  is  retained,  distending  the  uterus 
quite  firmly  and  giving  a  tension  much  like  that  of  preg- 
nancy, but  the  two  horns  are  alike  and  there  is  but  one  cor- 
pus luteum.  Usually  in  such  cases  no  uterine  seal  is  pres- 
ent. When  the  organ  is  distended  with  pus,  the  contents  do 
not  move  as  freely  as  the  fetal  liquids.     The  uterine  walls 


Palpation  of  the  Uterus  per  Rectum  125 

are  soft  and  flabby  with  a  moderate  amount  of  thickening, 
or  they  are  tense  and  at  some  place  an  abscess  may  point,  or 
the  organ  is  very  dense,  with  thick,  hard  walls. 

As  pregnancy  advances,  additional  evidences  appear.  The 
uterus  becomes  very  greatly  enlarged,  the  walls  are  tense, 
and  the  fetal  fluids  are  quite  readily  recognized  as  such. 
Later,  cotyledons  are  palpable  through  the  uterine  wall  and 
when  pregnancy  has  reached  four  to  five  months  one  will 
occasionally  recognize  the  fetus  itself  floating  in  its  fluids. 
The  fetus  becomes  increasingly  easy  of  recognition  as  preg- 
nancy advances.  In  some  cases,  however,  both  fetus  and 
uterus  fall  forward  into  the  abdomen  and  may  be  beyond 
the  reach  of  the  examiner.  In  such  cases  there  is  still  good 
evidence  of  pregnancy.  The  vagina  is  drawn  far  forward, 
the  cervix  has  been  dragged  anterior  to  the  pubis,  and  the 
vaginal  end  of  the  uterus  constitutes  a  large,  thick,  firmly 
stretched  band  passing  downward  and  forward  beyond  the 
examiner's  reach.  This  of  itself  does  not  indicate  preg- 
nancy with  absolute  certainty,  because  the  same  displace- 
ment of  the  uterus  also  occurs  from  the  presence  of  large 
uterine  or  ovarian  tumors,  from  extensive  pyometra,  or  from 
other  pathologic  conditions  which  would  cause  an  increased 
weight  of  the  organ.  The  application  of  the  uterine  forceps 
to  the  cervix,  followed  by  traction  on  these,  thus  drawing 
the  uterus  upward  and  backward,  to  or  into  the  pelvis,  as 
already  advised,  is  of  supreme  importance  in  making  an 
accurate  diagnosis  in  these  cases.  No  other  means  alone 
can  afford  so  great  assistance  and  security.  In  this  emer- 
gency, however,  other  signs  appear  to  aid  the  examiner  in 
making  his  diagnosis.  As  a  general  rule,  the  diagnosis  can 
be  verified  by  the  presence  of  the  uterine  seal,  by  abdomi- 
nal ballottement,  or  by  palpation  of  the  enormously  en- 
larged uterine  arteries.  In  some  instances  it  is  practicable 
to  diagnose  the  physical  well-being  of  the  pregnancy.  It  is 
easy  to  diagnose  desiccation  of  the  fetus  from  the  time 
when  the  interplacental  hemorrhage  occurs.  When  the 
metritis  of  pregnancy  is  so  far  advanced  that  abortion  is 
not  very  distant,  it  may  be  diagnosed  by  vaginal  and  rectal 


126  Diseases  of  the  Genital  Orgaris 

palpation,  even  though  the  fetus  be  yet  alive,  but  this  is  not 
as  easy  in  the  cow  as  in  the  mare.  In  the  latter  I  have  been 
able  to  pass  my  finger  through  the  wide,  short  cervical 
canal,  from  which  the  uterine  seal  had  disappeared,  palpate 
the  suppurating,  necrotic  area  of  the  chorion  about  the  os 
uteri  internum,  and,  beyond,  touch  the  active  fetus.  In  the 
cow  this  is  impracticable,  but  one  may  recognize  by  vaginal 
examination  the  disease  or  destruction  of  the  uterine  seal 
or  portions  of  necrotic  chorion  in  the  cervical  canal  or  pro- 
truding into  the  vagina.  By  rectal  examination,  one  may 
recognize  clearly  the  paretic  uterus  of  metritis,  its  want  of 
tone,  its  flaccidity  at  the  cervical  end,  and  the  thickened 
wall.  By  these  means  I  have  been  able  to  make  the  diag- 
nosis "Pregnant,  but  unsafe"  and,  to  the  astonishment  of 
the  breeder,  have  my  diagnosis  verified  in  a  few  weeks  by 
the  cow  aborting.  The  dead  and  macerating  or  emphyse- 
matous fetus  and  such  displacements  as  torsion  of  the  uterus 
without  clinical  symptoms  are  clearly  diagnosed  by  rectal 
palpation.  The  palpation  of  the  pregnant  uterus  per  rec- 
tum has,  therefore,  a  very  wide  range  of  usefulness  and 
is  capable  of  important  advancement  by  further  study. 

Much  fiction  has  been  indulged  in  regarding  the  dangers 
from  palpation  of  the  gravid  uterus  per  rectum.  While 
some  persons  are  bungling  enough  to  rupture  the  rectum  in 
this  procedure,  that  is  not  the  fault  of  the  operation,  but 
merely  the  ignorance,  stupidity,  or  carelessness  of  the  ex- 
aminer. The  idea  that  abortion  may  be  caused  by  a  pru- 
dent rectal  palpation  is  no  better  founded,  if  as  well,  than 
the  unavoidability  of  rupturing  the  rectum.  A  stupid  ex- 
aminer might  rupture  the  gravid  uterus,  or  possibly  roll  it 
over  and  cause  torsion,  but  that  is  not  abortion,  and  does 
not  lead  to  abortion.  I  might  illustrate  the  safety  of  the 
examination  by  a  typical  incident  to  which  reference  will  be 
made  later.  I  was  examining  for  pregnancy  a  cow  which 
had  been  bred  145  days  previously.  The  findings  were  ex- 
ceedingly confusing.  I  palpated  the  uterus  for  one-half 
hour  before  I  finally  recognized  the  presence  of  torsion. 
The  cow  was  left  for  about  twenty  hours,  then  was  cast, 


The  Diagnosis  of  Twin  Pregnancy  127 

rolled  over  several  times,  released  and  caused  to  get  up, 
then  thrown  and  rolled  again.  In  all,  she  was  rolled  com- 
pletely over  six  times,  thrown  twice,  and  the  gravid  uterus 
palpated  with  considerable  vigor.  She  calved  easily  and 
without  assistance,  at  280  days.  Both  mother  and  calf  were 
healthy.  Thus,  she  endured  severe  uterine  torsion,  violent 
rolling,  and  prolonged  palpation  per  rectum,  without  visible 
disturbance  of  the  course  of  pregnancy. 

Some  veterinarians  are  afraid  to  apply  forceps  to  the 
cervix  of  a  pregnant  cow  or  mare  and  exert  traction.  The 
proper  application  of  the  uterine  forceps  to  the  cervix  does 
not  cause  any  material  disturbance  to  the  uterine  seal  and 
causes  only  the  most  trivial  wound  of  the  cervix.  The  trac- 
tion applied  to  the  cervix  by  any  veterinarian  of  very  ordi- 
nary prudence  is  not  so  great  as  the  tension  caused  upon 
the  same  parts  when  the  animal  is  lying  down  or  getting  up. 

Generally  life  can  be  recognized  in  the  fetus  by  rectal  ex- 
ploration long  before  it  can  be  by  auscultation  of  the  heart 
or  by  other  means.  When  the  cow  has  been  pregnant  four 
or  five  months,  the  fetus,  eight  to  twelve  inches  long,  when 
touched,  generally  reacts  to  the  impact  and  moves  in  a 
clearly  recognizable  manner. 

7.    The  Diagnosis  of  Twin  Pregnancy 

The  diagnosis  of  twin  pregnancy  can  be  made  only  by 
rectal  examination  and  is  especially  easy  in  the  cow  at  90  to 
120  days,  when  the  entire  uterus  may  generally  be  palpated, 
as  well  as  the  ovaries.  At  this  time,  if  the  twins  are  bicor- 
nual,  as  is  the  rule,  the  diagnosis  is  very  simple.  The  two 
horns  are  equal  in  size,  and,  as  discussed  in  the  following 
paragraph,  there  is  a  corpus  luteum  of  pregnancy  in  each 
ovary.  With  all  cardinal  symptoms  of  pregnancy  present, 
the  two  elements  mentioned  make  the  diagnosis  very  reli- 
able. Later,  when  the  uterus  becomes  greatly  enlarged  and 
passes  far  forward  in  the  abdomen,  the  diagnosis  is  more 
difficult  and  less  secure.  The  corpora  lutea  cannot  then  be 
felt,  as  the  ovaries  are  out  of  reach  and  the  uterine  horns 
cannot  be  well  compared.    The  diagnosis  of  twins  must  then 


128  Diseases  of  the  Genital  Organs 

rest  upon  the  palpation  of  two  fetuses,  and  there  is  no  cer- 
tainty whether  they   are  to   present   alike   or   alternately. 
Generally  they  alternate ;  one  presents  cephalically  and  the 
other  caudally.     In  campylorrhachis  and  schistocormus  re- 
flexus,  however,  we  meet  with  a  single  fetus  presenting 
both  by  its  cephalic  and  caudal  ends.    Double  monsters  may 
also  be  met,  confusing  the  examiner.    In  unicornual  twins, 
the  examiner  faces  great  difficulty.    Almost,  if  not  always, 
they  lie  end  to  end — either  head  to  head  or  tail  to  tail — caus- 
ing  an   enormous    elongation    of  the   gravid   horn   which 
reaches,  at  the  close  of  pregnancy,  double  the  length  of  the 
antero-posterior  diameter  of  the  abdominal  cavity,  necessi- 
tating the  doubling  of  the  uterus  upon  itself,  as  in  the  bitch. 
Then  the  fetuses  lie  side  by  side,  with  two  uterine  walls  be- 
tween them  and  their  contact  ends  lying  against  the  dia- 
phragm of  the  mother.    Their  free  ends — two  heads  or  two 
tails — lying  side  by  side,  are  directed  toward  the  pelvis. 
The  basal  fetus  presents  on  a  line  with  the  long  axis  of  the 
cervix ;  the  fetus  occupying  the  ovarian  end  of  the  horn  lies 
lateral  to  the  basal  fetus,  on  the  side  of  the  ovary  of  preg- 
nancy.   That  is,  if  unicornual  twins  are  in  the  right  horn, 
the  basal  fetus  presents  with  its  head  or  tail  towards  the 
cervix,  and  on  the  right  of  this  lies  the  other  fetus,  present- 
ing by  the  same  part  but  lying  to  the  right  of  the  cervix. 
The  ovary  may  now  be  pushed  toward  the  pelvis  and  its  two 
corpora  lutea  should  be  palpable.     On  the  left  the  non- 
gravid  horn  would  be  palpable.     In  one  cow  about  60  days 
pregnant,  unicornual  twins  were  quite  securely  diagnosable 
by  the  presence  of  two  typical  corpora  lutea  in  the  ovary  on 
the  pregnant  side.     That  does  not  make  twin  birth  neces- 
sary.   One  embryo  may  perish  and  be  absorbed  but  the  diag- 
nosis is  still  important  because  the  other  embryo  may  be  a 
"freemartin",  or  neuter,  though  born  singly.     If  a  good 
diagnosis  of  twin  pregnancy  has  been  made,  a  single  birth 
follows,  and  the  offspring  is  apparently  a  female,  its  sex 
mav  well  be  doubted. 


Diag7iosis  of  the  Duration  of  Pregnancy  1 29 

8.   Diagnosis  of  the  Duration  of  Pregnancy 

It  is  highly  important  that  the  veterinarian  shall  be  able 
to  diagnose  with  reasonable  accuracy  the  duration  of  an  ex- 
isting pregnancy.  As  already  related,  the  heifer  or  cow 
sometimes  comes  in  estrum  and  is  re-bred  perhaps  repeat- 
edly after  conception.  It  is  then  desirable  to  be  able  to 
state,  approximately,  the  stage  of  pregnancy  in  order  that 
it  may  be  determined  at  about  what  period  parturition  may 
be  anticipated.  When  heifers  or  cows  are  bred  in  pasture 
so  that  the  date  of  conception  is  practically  unknown,  the 
determination  of  the  duration  of  pregnancy  is  at  times 
sought  by  the  owner.  In  pedigreed  cattle,  when  pregnant 
females  come  in  estrum,  the  bull  is  sometimes  changed  and 
confusion  of  pedigree  results,  which  may  often  be  satisfac- 
torily solved  by  physical  examination  to  determine  the  dura- 
tion. Sometimes  conception  occurs  unexpectedly  and  a  de- 
termination of  the  stage  of  pregnancy  aids  in  determining 
how  it  occurred.  Thus  in  one  instance,  in  a  cow  supposed 
to  be  non-pregnant  which  showed  no  estrum,  examination 
led  me  to  say  that  she  was  pregnant  four  months.  The 
owner  was  certain  she  had  not  been  served,  but  it  was 
finally  recalled  that  four  months  previously  a  bull,  supposed 
to  be  too  young  to  copulate,  had  been  with  her  at  pasture. 
In  another  instance  a  pure-bred  Holstein  cow  purchased  a 
year  previously  as  pregnant  six  months,  had  not  calved,  had 
not  been  in  estrum  so  far  as  known,  and,  according  to  his- 
tory, had  at  no  time  been  where  a  bull  could  copulate  with 
her  unknown  to  the  custodian.  In  addition,  her  vagina  con- 
tained a  quart  or  more  of  highly  fetid  pus.  In  spite  of  such 
a  history,  I  pronounced  her  pregnant  six  months  and  the 
fetus  alive.  She  calved  true  to  diagnosis.  When  the  custo- 
dian saw  clearly  that  the  cow  was  to  calve  soon,  he  recalled 
that  she  had,  at  the  date  indicated,  escaped  to  the  premises 
of  a  Shorthorn  breeder,  though  it  was  not  known  that  she 
had  copulated  with  the  Shorthorn  bull. 

During  the  first  five  or  six  months,  the  stage  of  preg- 
nancy in  cattle  is  to  be  determined  by  the  transverse  diame- 
ter of  the  pregnant  horn  of  the  uterus.  During  the  latter 
9 


130  Diseases  of  the  Genital  Orga?is 

stages,  the  duration  is  to  be  determined  by  the  volume  of 
the  palpable  part  or  parts  of  the  fetus,  the  volume  of  the 
uterine  arteries,  and  to  some  extent  by  the  volume  of  the 
uterine  seal,  the  dilation  of  the  cervical  canal,  the  enlarge- 
ment of  the  udder,  and  the  sinking  of  the  pelvic  ligaments. 
In  a  heifer  of  medium  size,  pregnant  thirty  days,  the  gravid 
horn  is  about  one  to  one  and  one-quarter  inches  in  diame- 
ter. When  forty-five  days  pregnant,  the  gravid  horn  has 
increased  to  one  and  one-quarter  or  one  and  one-half  inches. 
At  sixty  days,  it  has  reached  about  one  and  three-quarters 
inches ;  at  ninety  days,  two  to  two  and  one-half  inches ;  at 
one  hundred  to  one  hundred  and  twenty  days,  three  to  three 
and  one-half  inches.  At  one  hundred  and  fifty  days,  the 
gravid  horn  is  four  and  one-half  to  six  inches,  and  at  one 
hundred  eighty  days,  seven  to  eight  inches.  In  the  cow, 
during  the  first  sixty  days,  the  uterus  is  somewhat  larger 
than  in  the  heifer,  and  later  is  not  quite  as  tense  as  in  the 
latter,  but  there  is  no  recognizable  difference  in  size. 

At  about  one  hundred  fifty  to  one  hundred  eighty  days, 
the  fetus  is  generally  palpable.  Frequently  it  is  palpable  at 
a  much  earlier  date  even  when  only  six  to  eight  inches  long, 
but  recognition  of  the  fetus  at  this  time  is  not  at  all  certain 
in  any  given  case.  Even  when  the  fetus  is  recognized  at 
this  early  date,  it  is  of  little  or  no  advantage,  as  a  means  for 
determining  the  stage  of  pregnancy,  over  the  transverse  di- 
ameter of  the  gravid  horn. 

Once  the  fetus  is  palpable,  its  age  is  to  be  judged  by  the 
volume  of  the  extremity  palpated.  The  length  of  the  fetus 
cannot  be  determined.  The  parts  usually  palpated  are  the 
head  or  the  anterior  feet  when  in  the  anterior  presentation, 
or  buttocks  when  in  posterior  presentation.  The  size  of 
these  will  vary  with  the  size  and  age  of  the  pregnant  animal 
and  with  breed.  The  Holstein  fetus  is  the  largest  commonly 
encountered  and  has  large  head  and  feet.  The  Jersey  pre- 
sents the  other  extreme.  The  examiner  is  to  bear  in  mind 
individual  variations  in  size  of  fetuses  also.  The  determina- 
tion of  the  stage  of  pregnancy  by  physical  examination  is 
evidently  only  approximation  but,  with  the  breeding  history, 


Diag7iosis  of  the  Duration  of  Pregnancy  131 

may  be  rendered  very  exact.  Thus  when  a  cow  or  mare  has 
been  bred  but  twice  with  an  interval  of  two  to  four  months 
between  and  the  two  dates  definitely  known,  the  veterinarian 
can  then  positively  state  by  which  service  the  animal  is 
pregnant. 

Depending  upon  the  value  of  the  animal  and  the  skill  of 
the  veterinarian,  the  rectal  palpation  of  pregnant  animals 
may  be  made  of  wider  use  to  breeders.  The  trained  human 
obstetrist  examines  his  patient  at  intervals  during  her  preg- 
nancy in  order  to  determine  if  all  is  well  and,  if  possible,  to 
recognize  any  impending  danger  to  mother  or  fetus.  So  in 
animals  there  is  an  interesting  and  useful  opportunity  for 
service.  Thus  in  the  cow  with  torsion  of  the  uterus,  to 
which  reference  was  made  above,  the  statement  is  quite  jus- 
tified that  this  examination  of  an  apparently  well  cow  saved 
the  lives  of  herself  and  fetus.  In  mares  and  cows  the  pos- 
terior presentation  of  the  fetus  is  as  a  rule  a  definite  peril. 
In  many  instances  definite  assistance  is  required  during  par- 
turition. If  the  presentation  were  known  in  advance,  close 
watch  might  be  kept  and  veterinary  aid  more  promptly  sum- 
moned. Perhaps  one  of  the  most  striking  instances  where 
the  diagnosis  of  the  presentation  of  the  fetus  would  prove  of 
tremendous  value  to  the  breeder,  is  in  the  transverse  or  bi- 
cornual  development  of  the  fetus  in  the  uterus  of  the  mare. 
In  the  commonest  of  these,  the  ventral  transverse  presenta- 
tion, virtually  every  foal  is  lost,  since  the  sacrifice  of  its  life 
in  the  performance  of  embryotomy  is  essential  to  any  hope 
for  the  life  of  the  mare.  Nevertheless,  the  mortality  in 
mares  from  this  presentation  is  appalling.  When  the  con- 
dition which  I  have  described  in  Veteri7ianj  Obstetrics  as 
"compound  rotated  bicornual  pregnancy"  is  encountered, 
no  foal  or  mare,  so  far  as  recorded,  has  emerged  from  the 
ordeal  alive.  It  seems  to  me  that  the  most  hopeful  outlook 
for  such  cases  would  be  to  diagnose  them  as  early  as  mid- 
term, and  either  bring  about  artificial  delivery  while  the 
fetus  is  yet  small,  or  resort  to  Caesarian  section  some  time 
during  the  eleventh  month. 


132  Diseases  of  the  GeJiital  Organs 

There  lies  before  the  veterinarian  an  interesting,  and  as 
yet  wholly  undeveloped  field  of  usefulness  in  watching  preg- 
nant animals  and  guarding  them  against  important  perils. 

9.    Palpation  of  the  Fetus  per  Vaginam 

Palpation  of  the  fetus  per  vaginam  generally  succeeds 
only  during  the  last  months  of  pregnancy.  At  this  time,  in 
many  cases,  some  portions  of  the  fetal  body,  usually  the 
head  and  two  anterior  feet,  rest  upon  the  vagina  posterior 
to  the  OS  uteri  externum,  occasionally  giving  the  inexperi- 
enced examiner  the  impression  of  extra-uterine  pregnancy. 

10.    Abdominal  Ballottement 

After  the  sixth  month  of  pregnancy,  in  the  cow,  the  but- 
tocks or  other  portions  of  the  fetus  usually  lie  in  close  con- 
tact with  the  abdominal  floor  of  the  lower  right  flank  re- 
gion. If  the  hand  is  placed  firmly  against  the  abdominal 
wall,  a  somewhat  vigorous  thrust  made  upward,  and  then 
suddenly  the  force  released,  but  the  hand  kept  in  contact 
with  the  parts,  the  adjacent  portion  of  the  fetus  is  pushed 
upward  in  its  fluids,  floats  for  a  moment,  and  then  drops 
back  against  the  examiner's  hand  with  a  recognizable  im- 
pact. This  is  a  good  sign  of  pregnancy,  but  not  always  re- 
liable. Sometimes  no  portion  of  the  fetus  chances  to  lie  in 
suflftciently  close  contact  with  the  abdominal  wall  to  render 
the  test  efficient.  On  the  other  hand,  a  tumor  or  a  very 
large  and  heavy  intestinal  calculus  might  mislead  the  ex- 
aminer when  the  animal  is  actually  sterile. 

11.    Auscultation  of  the  Fetal  Heart 

In  the  advanced  stages  of  pregnancy  it  is  frequently  possi- 
ble, by  careful  auscultation  of  the  abdominal  walls  over  the 
region  of  the  fetus,  to  detect  the  beat  of  the  fetal  heart, 
which  is  usually  at  least  twice  as  rapid  as  the  beat  of  the 
maternal  heart. 

The  abdominal  ballottement  and  the  auscultation  of  the 
fetal  heart  are  of  minor  value  to  the  skilled  veterinarian,  be- 
cause when  these  can  be  successfully  applied  the  other  signs 


The  Abderhalden  Reaction  133 

which  have  been  enumerated  should  have  decided  the  ques- 
tion long  before. 

12.    The  Abderhalden  Reaction 

Abderhalden (')  announced  in  1912  the  discovery  of  a 
highly  interesting  method  for  diagnosing  pregnancy  by  a 
laboratory  test.  A  test  fluid  is  made  from  placental  tissues, 
to  which  is  added  serum  from  the  animal  to  be  tested,  and 
the  mixture  is  placed  in  a  dialyzing  tube.  If  the  animal  is 
pregnant,  portions  of  the  ferments  existing  within  the  blood 
serum  dialyze  into  surrounding  distilled  water,  in  which 
they  may  be  recognized  by  a  delicate  purple  coloring,  upon 
the  addition  of  ninhydrin  followed  by  heat.  It  is  claimed 
that  the  placental  ferments  appear  in  the  blood  as  early  as 
eight  days  after  conception  and  disappear  within  fourteen 
to  twenty-one  days  after  the  expulsion  of  the  placenta.  In 
the  larger  domestic  animals  it  is  more  than  eight  days  be- 
fore any  placental  tissue  commences  to  form.  It  is  not  easy 
to  understand  how  a  test  for  placental  elements  can  act  until 
placental  tissues  exist.  The  statement  that  a  reaction  may 
occur  as  early  as  at  eight  days  is  probably  based  upon  re- 
searches upon  some  small  rodent,  where  the  placenta  de- 
velops much  earlier. 

Since  the  preparation  of  the  test  material  and  the  test  it- 
self are  very  complex,  requiring  delicate  laboratory  appara- 
tus and  highly  technical  skill,  the  test  is  expensive  as  com- 
pared to  its  value  in  the  veterinary  field.  Even  in  human 
obstetrics  and  gynecology,  where  the  cost  is  not  as  great 
an  element  and  where  an  accurate  physical  examination  is 
not  nearly  as  practicable  as  in  the  mare  and  cow,  the  test 
is  not  regarded  by  many  of  the  foremost  authorities  as  effi- 
cient, J.  Whitridge  Williams (-)  states,  "While  I  consider 
that  the  method  should  be  regarded  as  one  of  the  important 
recent  contributions  to  medicine,  I  do  not  believe  that  it  is 
destined  to  come  into  extensive  practical  use  for  several 
reasons :     First,  its  technic  is  so  complicated  that  it  can  be 

'Die  Serodiagnostik  der  Scliwangerschaft,  Deutsche  med.  Wochenschr., 
1912,  No.  46. 

'  Obstetrics,  19 17. 


1 34  Diseases  of  the  Gemtal  Orgayis 

satisfactorily  employed  only  by  especially  trained  labora- 
tory workers.  Second,  even  its  most  enthusiastic  advo- 
cates admit  that  the  results  fail  to  correspond  with  the  clini- 
cal findings  in  5  to  10  per  cent,  of  cases,  and  thirdly,  that  it 
is  available  only  in  normal  pregnancy,  as  it  gives  uncertain 
results  in  inflammatory  conditions  and  uterine  myomata, 
or  when  the  pregnancy  is  complicated  by  nephritis  or  tox- 
aemia." 

Graves  (0,  speaking  of  this  test,  states,  "Opinions  dif- 
fer as  to  the  present  value  of  the  Abderhalden  test  for  preg- 
nancy, some  regarding  it  as  too  inaccurate  to  be  of  much 
clinical  value,  while  others  consider  it  reliable  and  practical 
(McCord).  The  test  requires  much  skill  and  care,  there  be- 
ing numerous  chances  for  error.  For  that  reason  it  has  not 
yet  come  into  general  practical  use." 

Thus  for  woman,  where  accurate  diagnosis  is  most  im- 
portant, leading  authors  either  condemn  the  test  as  unre- 
liable or  seriously  question  its  value  in  the  present  state  of 
knowledge  concerning  it. 

Zell(')  concludes  that  the  test  is  very  reliable,  but  when 
questioned  admits  that  the  serum  of  a  cow  may  react  for 
twenty  or  more  days  after  abortion,  that  many  tests  are 
valueless  because  of  slight  errors  in  drawing  the  blood  or 
decanting  the  serum,  and  that  various  diseases  nullify  the 
value  of  the  test.  Finally,  he  admits  that  the  test  is  not  at 
all  sufficient  or  complete  within  itself  and  must  always  be 
considered  in  conjunction  with — not  as  a  substitute  for — 
physical  examination.  In  78  clinical  cases  summarized,  the 
test  was  erroneous  in  5  animals — or  6.4  per  cent.  Any 
fairly  good  diagnostician  can  be  more  accurate  by  physical 
examination.  Some  have  claimed  a  place  for  the  Abder- 
halden test  on  the  ground  that,  in  the  cow  and  the  mare, 
physical  diagnosis  is  impracticable  in  the  first  half  of  preg- 
nancy and  in  the  second  half  physical  examination  imperils 
the  pregnancy.  Neither  of  these  assumptions  is  true 
Should  the  test  become  simplified  and  its  accuracy  be  ad- 

'  Gynecology,  Graves,  Win.  I'.,  1917. 

'•'C.  A.  Zell,  The  AhderhaliU-n  Test  for  Pregnancy  in  Annnals,  jour.  .Viii. 
Vet.  Med.  Assn.,  Oct.,  1917.      New  Series  Vol.  5,  No.  i,  page  39. 


The  Abderhalden  Reaction  135 

vanced,  it  may  prove  valuable  in  sheep,  goats,  swine,  and 
carnivora,  where  rectal  palpation  is  not  practicable,  but  in 
these  a  diagnosis  is  rarely  of  sufficient  importance  to  war- 
rant the  cost. 

It  is  claimed  that  the  test  is  highly  valuable  in  cases  of 
sale  and  warranty,  but  at  the  same  time  it  is  admitted  that 
the  blood  of  a  cow  which  has  recently  calved,  and  presuma- 
bly also  of  one  which  has  recently  aborted,  gives  a  positive 
reaction  for  a  somewhat  indefinite  period.  Accordingly, 
even  though  a  test  is  positive  and  no  error  in  technic  has 
been  made,  the  Abderhalden  test  can  at  best  show  only  an 
alternative  result — that  is,  the  animal  either  is  or  has  re- 
cently been  pregnant.  Just  how  recently,  we  do  not  know. 
In  this  respect  it  is  inferior  to  physical  diagnosis,  because 
the  latter  shows  that  the  animal  is  actually  pregnant  at  the 
time  of  examination  and  in  many  cases  gives  valuable  in- 
formation as  to  the  safety  of  the  pregnancy. 

In  another  direction  the  Abderhalden  test  is  very  de- 
fective. In  examining  cows  for  sterility,  the  examiner 
must  decide  upon  the  spot  whether  a  cow  is  pregnant.  In 
many  cases  the  whole  value  of  his  work  in  relation  to  ster- 
ility depends  upon  a  prompt  and  accurate  diagnosis  without 
resort  to  laboratory  methods,  with  the  accompanying  de- 
lays and  difficulties.  For  example,  when  called  to  examine 
a  cow  which  has  proven  sterile,  at  about  the  time  for  a  re- 
turn of  the  estrual  period,  the  practitioner  needs  to  make  a 
prompt  and  accurate  diagnosis  and  apply  the  proper  handl- 
ing immediately.  If  he  cannot  make  a  diagnosis  and  take 
prompt  action,  if  the  cow  is  nearing  estrum,  he  must  lose 
one  period  without  having  made  any  material  progress.  At 
present  it  seems  highly  improbable  that  the  Abderhalden 
test  for  pregnancy  is  destined  to  attain  a  prominent  place 
in  veterinary  medicine. 

The  physical  diagnosis  of  pregnancy  is  not  dependent 
upon  any  one  sign,  but  rather  upon  a  summary  of  all  signs, 
all  of  which  are  in  close  accord  and  are  available  to  the 
careful  examiner.  We  have  dealt  with  these  individually. 
They  should  always  be  considered  individually,  and  later 


136  Diseases  of  the  Genital  Orgajis 

collectively.  For  example,  if  an  animal  has  been  bred  for 
thirty  days,  if  estrum  has  not  recurred,  if  the  uterine  seal 
is  present  and  definite,  if  one  of  the  horns  is  larger  than  the 
other,  and  on  the  same  side  with  the  enlarged  horn  there  is 
a  typical  corpus  luteum  of  pregnancy,  the  cow  is  pregnant, 
and  the  diagnosis  is  as  accurate  and  secure  as  any  diagnosis 
which  we  can  make.  Other  signs  exist  which  may  aid  us 
and  add  to  the  security  when  any  one  of  these  fundamental 
signs  is  absent  or  in  some  manner  clouded.  With  experi- 
ence and  care,  any  veterinarian  can  learn  to  make  a  safe 
and  accurate  diagnosis  of  pregnancy  by  physical  examina- 
tion. 

Certain  other  signs  of  pregnancy  frequently  relied  upon 
have  a  minor  value.  One  of  the  commonest  physical  signs 
of  pregnancy  is  a  change  in  the  volume  and  form  of  the  ab- 
domen. However,  this  is  not  in  itself  dependable.  Many 
non-pregnant  animals  have  greatly  enlarged  abdomens,  and 
many  in  advanced  pregnancy  show  but  little  enlargement  of 
the  abdomen.  In  a  heifer,  gaunt  from  advanced  tuberculo- 
sis and  believed  non-pregnant,  I  diagnosed  twins,  to  which 
she  gave  birth  a  few  weeks  later. 

The  enlargement  of  the  mammae  is  generally  a  reliable 
sign  of  advanced  pregnancy,  but  some  cows  do  not  show 
marked  enlargement.  In  other  cases  sterile  heifers  lactate 
freely.  I  saw  one,  which  was  not  and  had  not  been  preg- 
nant, yield  twenty  pounds  of  milk  daily. 

13.    Confusing  Findings  in  Examination  for  Pregnancy 

While  engaged  in  rectal  palpation,  one  sometimes  en- 
counters conditions  which  confuse  the  examiner,  at  least 
temporarily. 

a.  The  left  kidney,  in  all  cows,  is  displaced  somewhat  to 
the  right  and  appears  quite  pendulous.  It  is  much  larger  in 
the  living  than  in  the  dead  animal.  It  contains  a  great  vol- 
ume of  blood.  In  some  cases,  it  hangs  very  pendant,  and  an 
inexperienced  veterinarian,  coming  in  contact  with  it  for  the 
first  time,  may  for  a  moment  think  it  a  tumor. 


Conftising  Findings  in  Examination  for  Pregnancy         137 


Fig.  46.     Lipoma  of  Mesenteric  Fat  of  Large  Intestine.     Cow. 

/,  /,  /,  Large  intestine  ;   2,  2,  2,  cross  sections  of  loops  of  large 

intestine,  surrounded  by  fat  tumor. 


138  Diseases  of  the  Genital  Organs 

b.  Mesenteric  fat  tumors  of  immense  size  occur  now  and 
then,  chiefly  in  the  mesentery  of  the  large  intestines,  as  seen 
in  Fig.  46.  I  have  seen  these  mostly  in  Guernseys  and  Jer- 
seys. They  consist  of  great  masses  of  necrotic  fat,  hard, 
marbled,  and  iridescent  on  section.  They  are  quite  movable 
in  the  abdomen.  In  my  first  case,  I  v^as  greatly  confused, 
and  suspected  that  I  had  to  do  v^ith  an  extra-uterine  fetus. 
It  was  too  far  forward  to  permit  of  complete  palpation. 
There  is  no  occasion  for  such  error.  In  extra-uterine  preg- 
nancy the  fetus  is  firmly  moored  by  adhesions  to  the  abdomi- 
nal floor.  While  I  have  no  definite  history,  my  museum  speci- 
mens show  the  fetus,  or  fetuses,  to  be  firmly  encapsuled  by 
adhesions,  so  that  they  are  compressed  into  the  narrowest 
space  possible,  but  where  and  how  they  were  attached  I 
have  no  history.  When  the  examiner  is  on  his  guard,  the 
mesenteric  fat  tumors  have  in  my  experience  admitted  of 
ready  diagnosis.  Their  relation  to  the  intestines  constitutes 
the  chief  guide.  I  have  seen  them  in  old,  or  at  least  adult, 
cows  only.  They  may  be  of  any  size.  In  one  case  the  entire 
abdomen  appeared  to  be  filled  with  these. 

c.  Dislocation  of  the  rumen  is  also  a  very  disconcerting 
condition  when  first  met.  In  one  cow,  to  all  external  ap- 
pearances in  perfect  health,  the  rumen  was  extremely  dis- 
located. The  right  sac  had  glided  across  the  abdominal  floor 
and  had  come  to  rest  against  the  right  abdominal  wall,  above 
the  level  of  the  pubis.  The  left  sac  of  the  rumen  had  de- 
parted from  the  left  sub-lumbar  region  and  dropped  down 
until  it  lay  only  slightly  above  the  pubis.  The  massive  or- 
gan thus  lay  on  the  abdominal  floor.  Its  normal  left  wall 
had  become  its  floor;  its  right  wall  faced  upward.  The 
rumen  occupied  the  entire  abdominal  floor  in  front  of  the 
pubis,  and  projected  somewhat  above  it.  The  soft,  pulta- 
ceous  rumenal  contents  were  readily  recognizable.  The  or- 
gan could  be  clearly  distinguished  and  traced.  The  genital 
organs,  uterus,  and  ovaries  passed  directly  forward  and  lay 
upon  the  dislocated  rumen.  The  dislocation  is  apparently 
of  no  consequence,  except  for  the  confusion  it  may  cause 
during  rectal  palpation. 


Confusing  Findings  in  Examination  for  Pregnancy        i  39 

d.  Extensive  pyometra  has  caused  colleagues  of  consid- 
erable experience  to  diagnose  pregnancy.  In  one  instance, 
pregnancy  had  been  diagnosed  in  a  well-bred  cow.  She  was 
sold  at  a  high  figure  and  shipped  a  long  distance.  She  was 
finally  returned  by  the  purchaser  at  heavy  cost.  When  I  ex- 
amined her,  I  siphoned  out  3  to  4  gallons  of  a  thin,  very 
fetid  pus.  In  another  instance,  a  heifer  purchased  as  preg- 
nant, having  gone  beyond  her  supposed  duration  of  preg- 
nancy, was  examined  and  a  macerating  fetus  diagnosed.  I 
siphoned  out  about  13  liters  of  a  very  thin,  odorless,  yellow 
pus.  In  each  case  there  was  no  observable  purulent  dis- 
charge, though  the  cervical  canal  was  freely  open.  The 
uterus  lay  far  forward  (neither  colleague  had  applied  for- 
ceps and  drawn  the  uterus  back)  and,  finding  it  distended  to 
the  volume  of  six  months  or  more  pregnant,  the  colleague  in 
each  case  erred  and  diagnosed  pregnancy.  The  uterus  was 
too  flaccid  for  pregnancy  and  its  walls  were  too  thick.  When 
traction  was  applied  and  the  uterus  drawn  backward  and 
upward  until  the  entire  organ  was  in  reach,  it  was  per- 
fectly clear  no  large  fetus  or  fetal  cadaver  was  present. 

It  is  true  that  often  the  gravid  uterus  drops  far  downward 
and  forward,  especially  in  old  cows  with  pendant  bellies, 
but  fetal  cotyledons  are  in  reach  even  if  the  fetus  is  not. 
The  veterinarian  should  also  seek  evidence  from  the  uterine 
arteries.  Pyometra  cannot  cause  an  enlargement  of  the 
arteries  at  all  comparable  with  the  enlargement  of  preg- 
nancy. 

e.  Cystic  Uterus.  The  uterus  of  the  cow  occasionally  be- 
comes cystic  and  causes  the  veterinarian  to  err  in  diagnos- 
ing pregnancy.  There  may  be  five  to  ten  gallons  of  lymph 
or  thin  mucus  in  the  uterine  cavity,  the  organ  dropped  far 
forward  and  very  flaccid.  There  is  no  recognizable  dis- 
charge.   The  cervical  canal  is  usually  free. 

In  another  group  of  cases,  there  is  a  blocking  of  the  cervi- 
cal canal  owing  to  one  of  the  annular  mucous  folds  acting 
as  a  valve  to  retain  menstrual  debris.  This  causes  a  tense 
filling  of  the  uterus  which  is  much  like  pregnancy,  but  the 
uterine  seal  is  ordinarily  absent,  there  is  probably  no  corpus 
luteum  typical  of  pregnancy,  the  arteries  are  not  enlarged, 
and  the  two  uterine  horns  are  distended  alike. 


Chapter  III 

ARTIFICIAL  INTERFERENCES  WITH 
REPRODUCTIVE  FUNCTIONS 

A.  The  Artificial  Induction  of  Estrum 

The  artificial  induction  of  estrum  has  a  wide  application 
in  cattle  breeding  and  in  dairying,  but  has  not  been  rendered 
available  in  other  species  of  animals. 

Aphrodisiacs.  Yohimbin  Spiegel.  For  many  years  nu- 
merous drugs  have  been  credited  with  the  power  of  arousing 
the  sexual  appetite  and  powers.  Among  these  are  canthar- 
ides,  turpentine  and  the  balsams  and  resins  and,  more  re- 
cently, a  new  drug,  yohimbin,  has  been  introduced  to  over- 
come sterility.  In  large  doses,  these  drugs  induce  more  or 
less  irritation  of  the  urino-genital  tract  and,  apparently, 
stimulation  of  the  sexual  desire. 

It  has  not  been  shown  that  aphrodisiacs  stimulate  ovula- 
tion and  spermatogenesis.  From  all  data  at  hand,  they 
merely  arouse  the  sexual  appetite  without  increasing  the  re- 
productive powers.  In  the  minds  of  some,  vigorous  sexual 
desire  signifies  exalted  breeding  powers,  but  this  is  a  false 
assumption.  In  nymphomania,  for  example,  the  sexual  ap- 
petite is  intense  and  the  breeding  power  nil.  Sexual  appe- 
tite, without  normal  ovulation  in  the  female  and  the  forma- 
tion of  normal  spermatozoa  in  the  male,  has  no  value,  but  is 
rather  a  harm,  frequently  leading  the  owner  astray  and  di- 
minishing the  value  of  the  patient  for  other  purposes. 

A  few  years  ago  vigorous  propaganda  brought  into  notice 
yohimbin  spiegel  as  a  magical  sex  tonic  and  a  great  weapon 
against  sterility.  The  pathology  of  the  cases  where  it  was 
alleged  to  give  relief  was  not  recorded.  It  was  used  almost 
wholly  in  females  which  failed  to  come  in  estrum,  but  why 
they  failed  no  intimation  was  given. 

Holterbach  (Berlin  Tienirztliche  Wochenscrift,  No.  9, 
1908),  in  an  exhaustive  article,  champions  the  use  of  the 
drug.     He  used  it  in  87  cases  of  absence  of  sexual  desire — 


The  Artificial  Induction  of  Estrmn  141 

22  cows,  9  bitches,  3  bulls,  and  3  sows.  In  his  observation, 
the  drug  has  a  greater  affinity  for  the  female  than  for  the 
male  genitalia.  A  five-year-old  Simmerthal  cow  calved  nor- 
mally in  June,  1906,  but  estrum  did  not  follow.  All  other 
drugs,  including  cantharides,  proved  useless.  In  August, 
1907,  fourteen  months  after  calving,  16  tablets  of  yohimbin 
chloride,  each  containing  0.1  gram  of  the  alkaloid,  were  pre- 
scribed, one  tablet  to  be  given  three  times  daily  in  the  drink- 
ing water.  On  the  third  day  there  was  excitement,  bellow- 
ing, uneasy  stepping  about,  frequent  urination  and  de- 
creased milk  flow.  On  the  fourth  day  there  was  a  muco- 
sanguineous  discharge  from  the  vulva  (menstruation?)  and 
on  the  fifth  day  the  owner  noted  expulsive  efforts  resembling 
labor  pains.  The  external  genitals  were  swollen  and  hyper- 
aemic,  but  no  estrum  was  present.  The  uterus  was  large. 
The  ovaries  were  enlarged,  but  not  cystic.  Six  weeks  later, 
the  cow,  showing  violent  estrum,  was  bred  and  the  owner 
"believed"  her  in  calf. 

Another  cow,  nine  months  post  partum  ,without  estrum, 
and  having  cystic  ovaries,  was  treated  in  the  same  way,  de- 
veloped estrum  ten  weeks  later  and  was  bred.  The  owner 
"believed"  her  to  be  pregnant. 

So  far  as  can  be  seen  from  Holterbach's  reports,  the  evi- 
dence is  not  convincing.  In  no  case  was  the  cause  of  non- 
estrum  explained,  and  no  proof  was  submitted  that  the  es- 
trum, following  the  use  of  yohimbin,  was  due  to  the  drug. 

Frubinger  (D.  M.  W.  No.  7,  1907)  condemns  the  drug  as 
worthless  and  attributes  the  alleged  cures  in  man  to  sug- 
gestion. 

Miiller  (Arch.  Internat.  Phar.  et  de  Therap.,  Vol.  XVII, 
p.  81)  considers  it  an  erratic  aphrodisiac,  acting  differently 
on  different  individuals.  Daels,  quoted  by  Holterbach,  ex- 
perimentally caused  menstruation  in  bitches  already  in  es- 
trum, but  bitches  usually  menstruate  at  this  time  anyhow. 
In  another,  not  in  estrum,  but  date  of  probable  normal  es- 
trum not  named,  menstruation  occurred  in  four  days.  A 
third  bitch  showed  a  mucous  discharge.  Later,  bloody  feces 
were  voided  and  the  animal  died  from  the  toxic  effects  of 


142  Diseases  of  the  Genital  Orgayis 

the  drug.  Autopsy  showed  enlarged,  congested  genital 
canal,  prominent  ripe  ova,  etc. 

In  experiments  on  young  bitches  less  than  nine  months 
old,  the  drug,  in  fatal  toxic  doses,  failed  to  cause  reaction  in 
the  genital  organs, 

I  used  the  drug  experimentally  upon  several  cows  in 
which  I  had  otherwise  failed  to  induce  estrum,  but,  like 
other  efforts,  it  was  without  avail.  In  one  cow  there  were 
ovarian  adhesions;  in  another,  cystic  degeneration  of  the 
ovaries,  etc.  The  drug  has  dropped  out  of  notice  except  for 
an  occasional  medicine  vendor  who  adheres  to  "patent  medi- 
cine" ideals.  The  failure  of  an  adult,  non-pregnant  female 
to  come  in  estrum  at  the  proper  time  is  due  to  some  patho- 
logic condition,  the  removal  of  which  is  followed  by  estrum. 
But  the  removal  of  the  cause  of  non-estrum  must  be  the 
basis  for  action  in  each  case.  These  pathologic  conditions 
will  be  discussed  in  their  proper  places.  In  some  cows  es- 
trum is  not  very  evident,  or  the  keeper  fails  to  recognize  it. 
The  animal  may  be  healthy  or  unhealthy.  It  is  important 
in  some  healthy  cows  to  get  definite  track  of  the  estrum.  If, 
upon  the  examination  of  an  animal  in  which  estrum  is  not 
observed,  the  general  health  is  good,  the  genital  organs  nor- 
mal, and  a  corpus  luteum  present,  it  is  sufficiently  clear  that 
at  some  former  date  the  animal  had  been  in  estrum  and  had 
ovulated.  If  the  corpus  luteum  is  dislodged  by  compressing 
it  per  rectum,  the  animal  will  quite  certainly  be  in  estrum 
in  three  or  four  days. 

In  some  cases  it  is  desirable  to  interrupt  the  estrual  cycle 
because  several  females  are  in  estrum  simultaneously  and 
the  service  of  all  would  overwork  the  herd  bull.  The  vet- 
erinarian can,  by  dislodging  the  corpus  luteum,  adjust  the 
estrual  cycle  at  will. 

Healthy  cows  sometimes  fail  to  ovulate  promptly  after 
parturition,  thereby  causing  a  delay  in  re-breeding.  When 
a  cow  does  not  show  estrum  within  sixty  days  after  par- 
turition, if  she  is  healthy,  the  corpus  luteum  of  pregnancy 
is  probably  tardy  in  disappearing.  It  then  becomes  of  im- 
portance to  the  dairyman  that  the  yellow  body  shall  be  dis- 
lodged and  the  cow  caused  to  come  in  estrum. 


A ;  iijicia  I  In  sem  in  a  tio  n  143 

The  veterinarian  should  constantly  remember  that  es- 
trum  and  ovulation  come  as  a  matter  of  course  in  healthy 
females  of  breeding  age  and  that  when  estrum  fails  it  is 
because  of  general  ill  health  or  some  other  restraining 
cause.  No  drug  has  yet  been  discovered  which  can  di- 
rectly cause  estrum  or  ovulation.  The  restoration  of  the 
general  health,  relief  from  distinctively  genital  diseases, 
and  the  surgical  dislodgment  of  the  inhibiting  corpus  lu- 
teum,  when  present,  constitute  the  fundamental  principles 
in  regulating  estrum  and  ovulation. 

B.     Artificial  Insemination.     Artificial  Impregnation 

Artificial  insemination  or  impregnation  has  been  advo- 
cated by  a  limited  number  of  veterinarians  and  breeders. 
The  advocacy  has  been  based  upon  various  hypotheses  and 
facts,  but  the  operation  has  not  come  into  extended  use.  At 
present  there  are  no  indications  that  the  scheme  will  ever 
occupy  an  important  place  in  livestock  husbandry. 

Artificial  insemination  is  not  difficult  and  there  can  be  no 
question  of  its  efficacy  in  fertilization.  It  has  been  advo- 
cated in  two  distinct  fields— to  conserve  the  sexual  powers 
of  valuable  sires  by  causing  numerous  fertilizations  from  a 
single  coitus  and  also  to  insure  fertilization  in  a  female 
otherwise  sterile. 

The  fertilizing  of  many  females  by  a  single  coitus  is  of 
course  technically  possible,  and  has  appealed  very  strongly 
to  some  owners  of  fashionable  sires.  Technically,  in  all  ani- 
mals there  are  millions  of  spermatozoa  ejaculated  at  each 
coitus,  of  which  but  one  can  take  part  in  the  fertilization  of 
an  Q^^,  and  the  millions  of  others  must  perish.  Any  at- 
tempt to  conserve  these  millions  of  spermatozoa,  when  from 
a  valuable  sire,  has  much  in  it  to  appeal  to  some  owners, 
and  comparatively  simple  means  are  at  hand  for  carrying 
out  the  operation.  The  prime  essentials  to  possible  arti- 
ficial fertilization  are  that  the  spermatozoa  shall  be  obtained 
promptly  after  ejaculation  by  the  male,  kept  moist,  the  tem- 
perature maintained  at  approximately  that  of  the  body 
(100  to  105  degrees,  F.),  and  introduced  into  the  genital 


144  Diseases  of  the  GeJiital  Organs 

canal  of  the  female  with  sufficient  promptness  that  the 
spermatozoa  shall  have  lost  none  of  their  vigor.  In  large 
animals  (horse  and  covv^)  semen  may  be  collected  immedi- 
ately after  coitus  by  introducing  the  hand  into  the  vagina, 
using  it  as  a  ladle  to  gather  up  and  withdraw  the  contents, 
and  may  then  be  placed  in  a  wide-mouthed  bottle  or  other 
vessel,  immersed  in  water  at  a  temperature  of  100  to  105' 
F.  The  semen  may  then  be  diluted,  if  required,  by  adding 
sterile  physiologic  salt  solution  of  body  temperature.  Di- 
luted or  undiluted,  the  semen  may  be  introduced  into  the 
vagina,  cervical  canal  or  uterine  cavity  of  another  female 
which  it  is  desired  to  fertilize.  The  introduction  may  be 
made  with  a  syringe,  a  funnel  fitted  with  a  tube,  or  other 
apparatus. 

Spermatozoa  have  been  kept  artificially  in  a  motile  state 
for  many  hours.  In  the  healthy  genital  tract  they  presuma- 
bly retain  their  motility  for  days.  Motility  of  the  sperma- 
tozoa is  not  proof  of  fertilizing  power,  and  no  satisfactory 
data  are  at  hand  indicating  how  long  after  ejaculation  sper- 
matozoa retain  vigorous  fertility.  It  is  probably  for  a  few 
hours  only  when  in  the  healthy  genital  tract,  where  the 
spermatozoa  unquestionably  live  longer  than  when  kept  out- 
side the  body.  In  mares  and  cows,  rape  is  occasionally  in- 
duced by  the  breeder,  under  the  belief  that  it  will  cause  es- 
trum  to  appear  soon.  In  other  cases,  the  female  has  been  in 
estrum,  which,  before  opportunity  for  coitus  has  occurred, 
ceases  and  the  owner  hopes  by  belated  coitus,  under  com- 
pulsion, to  secure  fertilization.  Rape  virtually  always,  if 
not  always,  fails  of  results.  It  is  reasonable  to  assume  that 
artificial  insemination  can  be  no  more  productive  of  results 
than  rape.  Mule  breeding  is  based  upon  approximate  rape, 
but  the  resistance  of  the  mare  is  not  because  she  is  not  in 
estrum  but  owing  to  her  repulsion  to  coitus  with  the  ass. 
It  appears  that  artificial  insemination  must,  therefore,  ap- 
proximate the  essentials  of  physiologic  coitus.  The  sperma- 
tozoa need  to  be  transferred  promptly,  during  estrum.  The 
suggestion  that  semen  may  be  transported  long  distances 
and  used  successfully  should  be  discounted  liberally  until 


Artificial  Insemination  145 

further  evidence  is  adduced.  The  allegations  of  some  en- 
thusiasts that  artificial  insemination  succeeds  whether  the 
female  is  in  estrum  or  not  is  without  supporting  evidence 
and  appears  absurd. 

Artificial  insemination  has  numerous  objectionable  feat- 
ures. So  far  as  I  am  aware,  no  livestock  association  offi- 
cially recognizes  such  fertilization  for  purposes  of  record  of 
pedigree.  The  moral  hazard  in  recording  pedigrees  is  al- 
ready great  and  artificial  insemination  would  open  a  new 
avenue  to  fraud. 

While  the  millions  of  spermatozoa  ejaculated  at  each 
coitus  are  technically  capable  of  infinite  fertilizations,  some 
are  dead  and  some  defective  from  the  first,  and  most  of 
them  succumb  to  bacterial  or  other  injury  while  en  route 
from  the  vagina  to  the  ovary,  so  that  their  numbers  are 
greatly  reduced  before  they  have  reached  the  pavilion  of 
the  oviduct.  As  soon  as  the  spermatozoa  are  apportioned 
between  two  or  more  animals,  the  certainty  of  fertilization 
decreases.  It  is  clearly  impossible  to  keep  the  spermatozoa 
as  well  outside  the  body  as  within  the  genital  tract,  and 
slight  error  in  technic  may  destroy  completely  the  fertiliz- 
ing power. 

The  chief  menace  from  artificial  insemination  is  the  trans- 
fer of  infection.  In  natural  coitus,  when  the  semen  is  ejacu- 
lated into  the  vagina,  there  may  be  present  infection  from 
both  the  male  and  the  female  genital  organs.  Most  infec- 
tions, so  far  as  known,  are  non-motile.  This  affords  oppor- 
tunity for  the  vigorously  motile  spermatozoa  to  move  away 
from  the  infection,  elude  the  dangers  ,and  effect  fertiliza- 
tion. Semen  taken  from  the  vagina  of  one  female  contains 
the  bacteria  from  herself  and  the  male  and,  when  introduced 
into  the  vagina  of  a  second  female,  carries  for  her  a  double 
danger.  If,  as  is  generally  advocated,  the  insemination  is 
made  intra-uterine,  the  danger  from  infection  is  greatly  in- 
creased. 

Artificial  insemination  has  also  been  advocated  as  a 
remedy  for  sterility.  When  first  proposed,  atresia  of  the 
cervical  canal  was  considered  one  of  the  chief  causes  of 


146  Diseases  of  the  Genital  Organs 

sterility.  Had  that  been  true,  the  plan  would  have  had 
merit.  Later  developments  show^  clearly  that  cervical 
atresia  is  essentially  negligible  as  a  cause  of  sterility.  Ar- 
tificial insemination  has,  therefore,  only  a  very  limited  and 
questionable  place  in  the  treatment  of  sterility.  Diseases  of 
the  vagina,  cervix,  and  uterus  which  might  cause  sterility 
are  more  readily  remedied  by  other  means  than  by  artificial 
insemination.  Diseases  of  the  oviducts  and  ovaries  cannot 
be  favorably  affected  by  the  operation.  Artificial  insemina- 
tion may  have  some  value  under  exceptional  conditions  in 
extending  the  breeding  range  of  highly  valued  sires,  and  in 
very  rare  cases  may  possibly  have  value  in  sterile  females. 

Artificial  Abortion 

Occasionally  artificial  abortion  in  animals  becomes  desir- 
able in  the  economic  interests  of  the  owner.  When  highly 
pedigreed  females  are  accidentally  permitted  to  copulate 
with  common  males  or  with  pedigreed  males  of  a  different 
breed,  the  progeny  is  valueless  and  the  span  of  the  pregnancy 
becomes  a  loss  to  the  owner  in  so  far  as  the  production  of 
valuable  progeny  is  concerned.  Sometimes,  also,  a  heifer 
calf  of  five  to  ten  months  unexpectedly  comes  in  estrum. 
copulates  with  a  bull,  conceives,  and,  unless  the  pregnancy 
is  artificially  interrupted,  is  much  damaged  by  repression 
of  growth  and  development. 

No  drug  is  known  which  is  capable  of  causing  a  pregnant 
animal  to  abort.  Ergot  and  other  drugs  have  been  cited  as 
ecbolics  or  abortifacients,  but  there  is  no  reliable  evidence 
that  any  one  of  them  is  competent  to  cause  abortion  di- 
rectly. Ergot,  given  repeatedly  and  in  large  doses,  finally 
poisons  the  pregnant  animal,  which,  just  prior  to  death,  may 
abort.  Such  abortion  is  probably  indirect ;  the  toxic  effect 
of  the  drug,  by  lowering  the  resistance  of  the  body,  may 
enable  the  infection  present  in  the  uterus  to  acquire  new 
power  and  precipitate  abortion. 

It  is  not  known  that  any  form  of  bacteria,  living  or  deail. 
or  any  of  their  toxins  or  other  products,  possesses  any  di- 
rect ecbolic  power,  if  by  this  term  is  meant  an  inherent 


Artificial  Abortion  147 

power  to  cause  contraction  of  the  uterus  with  the  expulsion 
of  its  contents. 

Many  veterinarians  and  research  workers  with  the  B. 
abortus  of  Bang  beheved  for  some  years  that  this  organism 
had  the  power  to  act  directly  as  an  abortifacient.  Professor 
Bang  made  no  such  claim,  so  far  as  I  have  found,  but  in- 
stead contended  that  the  abortion  was  the  result  of  an  endo- 
metritis for  which  he  believed  the  B.  abortus  responsible. 
If  the  B.  abortus  could  cause  abortion  by  directly  acting 
upon  the  central  nervous  system,  it  should  be  able  to  do  so 
when  the  bacillus  is  multiplying  elsewhere  than  in  the 
uterus  or  fetus,  but  in  all  cases,  when  the  aborter  is  promptly 
destroyed,  metritis  is  present  and  bacteria  are  recognized 
as  the  cause  of  the  metritis.  Hence,  so  far  as  known,  abor- 
tion can  not  be  caused  artificially  by  means  of  toxins  or 
other  bacterial  poisons. 

Artificial  abortion  is  quite  certainly  induced  by  breaking 
down  the  uterine  seal,  invading  the  uterus,  and  douching 
the  cavity.  The  earliest  date  after  copulation  at  which  abor- 
tion can  be  induced  by  uterine  douching  is  undetermined. 
Douching  the  uterus  with  a  disinfectant  immediately  after 
copulation  is  quite  certain  to  destroy  all  spermatozoa  and 
prevent  fertilization,  but  after  the  lapse  of  a  brief  time, 
certainly  less  than  an  hour  in  the  cow,  the  spermatozoa, 
having  passed  into  the  oviducts,  are  beyond  reach.  Mar- 
shall, citing  Hensen,  states  that  in  the  rabbit  the  spermato- 
zoa travel  from  the  vagina  to  the  ovary  in  from  fifteen  min- 
utes to  two  hours.  If  that  be  correct,  it  is  well-nigh  im- 
possible to  douche  the  uterus  early  enough  after  copula- 
tion to  prevent  fertilization.  Marshall  states  that  the  fer- 
tilized ovum  of  the  rabbit  enters  the  uterus  at  about  three 
days  after  fertilization.  During  this  interval  uterine 
douching  can  not  interrupt  pregnancy.  In  the  larger  domes- 
tic animals,  the  migration  of  the  fertilized  ovum  from  the 
pavilion  of  the  oviduct  into  the  uterus  is  believed  to  be 
slower  than  in  the  rabbit.  Marshall  (0  gives  the  duration 
of  migration  in  the  dog  as  eight  to  ten  days.    During  this 

'  Marshall,  A.  Milnes,  Vertebrate  Embryology,  1S93,  p.  47i- 


148  Diseases  of  the  Genital  Organs 

interval,  or  about  16  per  cent,  of  her  span  of  pregnancy, 
the  bitch  can  not  be  aborted  by  uterine  douching. 

Bonnet  believes  that  in  domestic  animals  generally  the 
tubal  migration  of  the  fertilized  ovum  requires  eight  to  ten 
days.  The  period  is  certainly  no  less,  and  I  suspect  that  in 
the  cow  it  is  longer.  In  one  cow,  which  had  long  been  ster- 
ile, I  douched  the  uterus  freely  with  2  per  cent.  Lugol's  so- 
lution thirteen  days  after  conception,  without  inducing 
abortion.  There  was  moderate  cervicitis  present,  and  I 
douched  from  the  cervical  end  of  the  uterus  some  mils,  of 
pus,  so  that  I  possibly  prevented,  instead  of  caused,  abor- 
tion. So  far  as  known,  artificial  abortion  in  the  cow  can 
not  be  brought  about  by  uterine  douching  until  at  least  eight 
to  ten  days  after  conception,  or,  judging  from  my  single 
experience,  not  until  an  even  later  date.  There  is  greater 
assurance  of  success  if  douching  is  deferred  until  about  the 
twentieth  day. 

In  douching  the  pregnant  uterus,  the  veterinarian  needs 
to  be  quite  cautious.  The  catheter  must  be  introduced  very 
gradually  and  carefully  through  the  cervical  canal,  since 
the  very  adhesive  uterine  seal  dulls  the  sense  of  touch  and 
renders  mechanical  injury  possible.  When  the  catheter  has 
entered  the  uterus  and  douching  is  attempted,  the  instru- 
ment generally  becomes  blocked  with  portions  of  the  uter- 
ine seal  and  no  safe  distension  of  the  uterus  with  fluid  will 
force  out  the  sticky  mass.  The  connecting  screw  between 
the  outer  and  inner  tubes  needs  to  be  loosened  and  the  inner 
tube  drawn  back  and  forth  until  the  plug  of  the  uterine  seal 
is  dislodged  and  washed  away. 

The  amount  of  fluid  introduced  should  be  noted  very  care- 
fully, and  great  care  taken  not  to  use  too  much,  because  the 
pregnant  uterus  is  very  easily  ruptured.  In  a  recent  publi- 
cation, a  veterinarian  records  a  case  of  "extra-uterine  preg- 
nancy" in  a  cow,  the  uterus  of  which  he  had  recently  douched 
and  ruptured,  thus  causing  the  fetus  to  become  extra-uter- 
ine. It  is  to  be  remembered,  since  up  to  the  fourth  month 
the  embryonic  sac  in  the  cow  lies  very  loosely  in  the  uterus, 
that  the  douching  fluid  pushes  the  maternal  and  fetal  pla- 
centae apart.    Then  the  detached  sac.  sucked  into  the  fenes- 


Artificial  Abortion  149 

tra  of  the  catheter,  prevents  the  return  of  the  fluid.  If  the 
catheter  is  removed,  the  detached  embryonic  sac  blocks  the 
cervical  canal,  the  distended  uterine  walls  contract,  rup- 
ture takes  place,  and  the  fetus  drops  into  the  peritoneal  cav- 
ity. Therefore  it  is  safer  to  introduce  a  fev^  ounces  of  fluid 
only,  thus  avoiding  the  peril  of  rupture.  The  fluid  should 
be  antiseptic,  because,  as  a  rule,  the  uterine  cavity  is  septic 
and  a  neutral  fluid  stimulates  the  bacteria  present.  The 
fluid  introduced  must  not  be  highly  irritant. 

While  the  induction  of  abortion  by  means  of  the  uterine 
douche  is  quite  reliable  in  bringing  about  the  expulsion  of 
the  uterine  contents,  it  is  neither  the  safest  nor  the  best 
plan.  Hess(0  was  first  to  draw  attention  to  the  reliability 
with  which  abortion  may  be  induced  in  heifers  and  cows  by 
dislodging  the  corpus  luteum  of  pregnancy.  This  operation 
possesses  the  great  advantage  over  the  preceding  plan  of 
causing  the  abortion  in  an  approximately  physiologic  man- 
ner. That  is,  it  acts  directly,  by  removing  the  inhibiting 
power  of  the  corpus  luteum,  and  establishes  uterine  con- 
tractions closely  simulating  those  of  parturition  and  men- 
struation, without  the  intervention  of  any  mechanical  insult 
to  the  cervix  and  uterus.  The  abortion  follows  in  one  to 
three  days. 

The  operation  is  easy  and  safe  in  early  pregnancy.  As 
late  as  ninety  to  one  hundred  and  twenty  days,  the  operator 
can  pick  up  the  ovary  of  pregnancy  per  rectum  with  one 
hand,  carry  it  back  over  the  vagina,  introduce  the  other 
hand  into  the  vagina,  grasp  the  ovary  through  its  roof,  and 
compress  the  base  of  the  corpus  luteum  firmly  between  the 
thumb  and  fingers  until  the  body  is  wholly  dislodged. 
Sometimes  the  yellow  body  breaks  up  under  pressure,  so 
that  only  a  portion  is  dislodged.  The  operator  should  be 
careful  to  press  it  all  out.  Later  in  pregnancy,  the  ovary 
can  not  be  carried  back  over  the  vagina.  In  small  heifers, 
the  vulva  may  not  permit  the  passage  of  the  hand.  Then  it 
is  essential  to  dislodge  the  corpus  luteum  by  compression 
from  the  rectum.     This  must  be  done  cautiously,  since  the 

*  Hess,  Professor  E.,  Schweitzer  Archives  fur  Tierheilkunde,  No.  6,  1906, 
P-  351- 


150  Diseases  0/  the  Genital  Organs 

rectal  walls  are  but  feebly  resistant  and  are  readily  in- 
jured. With  patience  and  care,  the  dislodgement  can  be 
carried  out  per  rectum  though  not  so  safely  as  per  vaginam. 
Artificial  abortion  is  rarely  advisable  after  the  sixth 
month,  especially  for  the  purpose  of  terminating  a  funda- 
mentally undesirable  pregnancy.  It  is  safer  in  such  cases, 
and  the  loss  of  time  is  little,  if  any,  greater  to  allow  the 
pregnancy  to  go  full  term  and  end  in  parturition.  Should 
occasion  arise  for  inducing  abortion  late  in  pregnancy,  it 
would  be  necessary  to  resort  either  to  breaking  down  the 
uterine  seal  and  douching  the  uterus,  or  to  performing  lapa- 
rotomy, if  the  ovary  of  pregnancy  has  been  dragged  beyond 
reach  per  rectum.  If  the  vagina  is  clean,  vaginectomy  may 
be  performed  as  in  spaying,  the  hand  and  arm  inserted,  and 
the  ovary  thus  reached.  However  abortion  is  induced,  once 
it  has  been  completed,  it  is  desirable  to  watch  the  progress 
of  the  case  and  determine  by  examination  of  the  genital  or- 
gans, including  uterine  douching,  whether  all  is  going  well. 


Chapter  IV 

ARRESTS  AND  ABERRATIONS  IN 
GENITAL  DEVELOPMENT 

A.  Asexual  or  Bisexual  Aberrations 

1.    Neuters,  Freemartins 

So  far  as  known,  cattle  lead  in  the  production  of  asexual, 
or  neuter  individuals.  This  may  be  only  apparent,  since  in 
cattle,  more  than  in  any  other  animal,  the  value  of  the  fe- 
male of  breeding  age  rests  almost  wholly  upon  its  reproduc- 
tive powers,  and  any  failure  to  breed  attracts  definite  atten- 
tion. It  may  be  that  sheep  and  goats  are  as  frequently  neu- 
ter but  that  the  condition  is  overlooked.  In  cattle  the  neuter 
is  ordinarily  one  of  a  pair  of  twins,  of  which  the  other  is  a 
male  and  commonly  fertile.  The  condition,  so  far  as  I 
know,  has  not  been  observed  when  the  other  twin  is  a  female. 
Numerous  theories  have  been  advanced  in  an  effort  to  ex- 
plain the  origin  of  freemartins,  or  neuters,  but  the  cause  of 
the  phenomenon  has  not  been  made  clear.  While  ordinarily 
the  neuter  is  twin  to  a  male,  I  am  unable  to  verify  the  gen- 
eral belief  that  this  is  universal.  It  has  been  my  privilege 
to  examine  clinically  several  neuters  which  had  been  regu- 
larly registered  in  official  herd  books  and  sold  as  heifers. 
The  rules  of  breeders'  associations  forbid  the  registration 
of  an  apparent  female  which  is  twin  to  a  bull  until  the  ani- 
mal has  conceived.  In  some  instances  where  the  animal  has 
not  been  sold,  but  has  been  bred  by  the  party  for  whom  the 
examination  was  made,  I  have  had  personal  assurances  that 
it  was  a  single.  Some  of  these  cases  may  be  due  to  fraud 
upon  the  part  of  the  breeder.  Other  animals  may  be  truly 
singles  in  so  far  as  birth  is  concerned,  but  the  conception 
may  have  been  twin  and  one  embryo  may  have  perished  and 
disappeared.  I  am  inclined  to  believe  that  neuters  rarely 
come  from  a  single  conception.  Accordingly,  when  examin- 
ing a  neuter  which  has  been  registered  and  sold  as  a  breeder, 


152 


Diseases  of  the  Genital  Organs 


I  always  feel  that  fraud  has  probably  been  committed, 
though  I  believe  that  exceptions  exist. 

In  the  most  typical  individuals,  no  distinctively  genital 
organs  exist,  but  traces  of  both  Wolffian  and  Mueller's  ducts 
are  present  and  may  be  clearly  traced.  No  ovaries  or  testes 
are  present,  but  very  tiny  undifferentiated  sex  glands  may 
be  recognizable. 

Every  gradation  of  development  is  encountered,  from  ab- 
solute neuter  to  complete  female,  but  the  direction  of  devel- 
opment in  cattle,  so  far  as  I  have  observed,  is  always  toward 
the  female — never  toward  the  male  or  toward  hermaphrod- 
itism. Hermaphroditism,  so  far  as  I  have  noticed,  is  rarer 
in  cattle  than  in  any  other  species  of  domestic  animal,  but 


OCL 

-pic.  47— Arrested  Development  of  the  Genital  Tract.     Bovine. 

MU,  Meatus  urinarius  ;     T,  vulva  ;  //,  hymen  ;    I'a,  vaccina  ;    U,  cordiform 
Muellerian  ducts  representing  the  uterus  ;    UC,  uterine  cornu,  excavated 
and  filled  with  fluid  (menstrual  debris)  ;   CL,  corpus  luteum  ;   O,  ovary. 

cattle  furnish  by  far  the  greatest  number  of  asexual  indi- 
viduals. 

The  development  of  the  genital  organs  in  the  embryo  be- 
gins at  the  anterior,  or  ovarian  end  and  progresses  toward 
the  vulva.  In  the  typical  asexual  individual,  the  genital 
glands  are  represented  by  indifferent  nodes,  yellow  in  color, 
about  the  size  of  an  ordinary  grain  of  wheat.  Both  the 
Muellerian  and  Wolffian  ducts  are  present  and  have  attained 
considerable  size.  They  do  not  become  tubular,  but  persist 
as  solid,  fibrous  cords.  All  four  structures  lie  on  a  common 
plane,  the  Wolffian  lateral  to  the  Muellerian  ducts  and  in 
close  contact  with  them.    The  ducts  of  Mueller  do  not  fuse 


Asexual  or  Bisexual  Aberrations 


153 


in  any  portion  of  their  length,  but  persist  as  contiguous, 
solid  cords.  The  first  suggestion  of  sex  specialization  is 
generally  an  excavation  of  the  Muellerian  ducts  at  the 
apices  of  the  uterine  horns,  as  shown  in  Figs.  51,  52.  Paral- 
lel with  this  there  may  be  some  suggestion  of  ovarian  de- 
velopment. The  next  observed  stage  of  excavation  of  the 
apices  of  the  uterine  horns  is  the  fusion  and  the  excavation 
of  the  Muellerian  ducts  in  the  area  of  the  uterine  body.  The 
cavity  of  the  excavated  uterine  horns  or  body  sometimes  be- 
comes distended  with  lymph,  usually  thin  and  clear. 


/  j^. 


I'      / 


Fig.  48— Arrested  Development  of  Bovine  Genital  Tract  (Freemartin. ) 
MU,  Meatus  urinarius  ;  //,  hymen  ;  IVD,  Wolffian  ducts  ;  DM,  ducts  of 
Mueller  ;  DiW  cross  section  of  Mueller's  ducts ;  GG,  undifferentiated 
genital  gland.  The  anterior  ends  of  the  Muellerian  Ducts,  DM,  between 
the  genital  glands,  GG,  are  excavated  and  distended  with  fluid. 


154 


Diseases  of  the  Genital  Orgayis 


Finally,  in  the  individuals  most  advanced  in  development, 
the  posterior  portions  of  the  cervico-vaginal  segments  show 
definite  advances  toward  physiologic  development.  When 
this  occurs,  there  is  parallel  development  of  the  ovaries  and 
the  genital  system  functions  more  or  less  normally.  Thus 
all  conceivable  gradations  occur  between  the  absolute  neu- 
ter and  the  fully  developed  female  sex  system. 


Fig.  49 — Same  as  Fig.  48,  with  further  Developuient  of  the  Muellerian 
Ducts.  Lettering  .same  as  in  Fij^.  4S.  except  BL  indicates  broad  lij^janiciU 
of  the  uterus  and  just  above  BL  al  DM,  the  ducts  oi  .Mueller  are  excavated 
and  distended. 


Asexual  and  Bisexual  Aberrations  1 55 

The  vulva  of  the  neuter  frequently  shows  at  birth  a  highly 
marked  tuft  of  vulvar  hairs,  strongly  suggestive  of  the  pre- 
putial tuft  of  the  bull.  In  the  typical  neuter  no  sexual  de- 
sire develops:  there  is  no  estrum.  The  head  and  neck  fail 
to  develop  that  fineness  of  lines  characteristic  of  the  heifer 
and  the  body  is  generally  somewhat  gross.  It  has  been 
stated  that  the  head  and  neck  are  like  those  of  the  bull,  but 
I  have  been  unable  to  verify  this.  To  me  they  seem  more 
like  those  of  a  steer — a  surgically  made  neuter.  The  horns 
are  rather  gross,  straight,  and  thick. 

As  soon  as  the  rectum  of  the  animal  is  large  enough  to 
admit  the  operator's  hand,  a  reliable  diagnosis  is  available. 
Upon  rectal  palpation,  the  urinary  bladder  is  prominent,  as 
in  the  bull ;  there  is  no  vagina  or  cervix,  but  instead  there 
are  two  hard,  fibrous  cords  the  size  of  lead  pencils  or 
smaller,  sometimes  so  closely  bound  together  that  they  feel 
as  one.  In  other  cases  careful  palpation  may  identify  all 
four  cords.  Wolffian  and  Muellerian  ducts.  The  length  of 
these  cords  varies  greatly.  Sometimes  they  are  as  long  as 
a  normal  genital  tract;  sometimes  very  short  and  blunt. 
Frequently  they  end  anteriorly  in  cystic  dilations  given  off 
at  almost  Aghi  angles.  Beyond  the  ends  of  these  dilations, 
the  operator  may  or  may  not  be  able  to  distinguish  the  un- 
differentiated tiny  sex  glands.  In  typical  cases,  the  diag- 
nosis is  easy,  and  fortunately  most  cases  are  typical.  In 
some  of  the  atypical  cases,  where  the  sex  development  has 
progressed  to  a  considerable  degree,  the  diagnosis  may  prove 
very  difficult.  Confusion  is  most  probable  in  those  cases 
where  a  large  proportion  or  all  of  the  uterine  horns  and  body 
have  become  excavated  but  the  cervix  remains  imperforate. 
The  uterus  and  horns  are  then  distended  with  lymph,  sim- 
ulating pregnancy.  As  a  rule,  however,  the  examiner  can 
recognize  by  palpation  some  fundamental  defect  in  vagina, 
cervix,  or  ovaries  which  will  make  the  diagnosis  clear.  The 
character  of  the  distension  itself,  as  I  have  observed  it, 
serves  readily  to  diiferentiate  the  condition  from  preg- 
nancy. The  uterus  is  flaccid  and  the  contents  mobile.  The 
horns  are   irregularly   distended,  broad  at  one  point   and 


156  Diseases  0/  the  Genital  Organs 

quite  narrow  at  another.  The  fluid  may  sometimes  be 
pressed  from  one  horn  to  the  other  through  the  uterine 
body.  This  is  in  sharp  contrast  to  the  distended  uterus  of 
pregnancy,  in  which,  if  the  pregnancy  is  healthy,  the  dis- 
tension is  firm  and  the  contained  fluids  fixed  in  the  fetal 
membranes.  If  a  careful  record  is  made  of  the  volume  of 
the  uterus,  and  it  is  re-examined  thirty  days  later,  the  uterus 
of  pregnancy  will  have  enlarged  markedly;  distension  of  a 
uterus  arrested  in  development  would  have  remained  essen- 
tially static. 


Fig.  50 — Same  as  Figs.  48,  49.     /,  Meatus  uriuarius  ;     2,  J,  WoltTian  ducts  ; 

J.   Muellerian  ducts  ;    7,  4,   excavated  and  distended  anterior 

(ovarian)  ends  of  MueUerian  ducts. 

The  mole,  or  uterine  cyst,  may  also  confuse.  Like  the 
uterus  of  arrested  development,  the  mole  may  remain  static 
for  months  and  the  uterus  may  be  flaccid.  In  this  instance, 
however,  the  genital  organs  are  anatomically  sound,  there 
is  a  corpus  luteum  of  pregnancy,  probably  a  typical  uterine 
seal,  and  a  distended  uterus,  static  in  size.  It  can  finally  be 
differentiated  by  sounding  the  cervical  canal.  The  condi- 
tion is  discussed  later. 

As  soon  as  the  neuter  character  of  the  animal  is  recog- 
nized, it  should  be  designated  for  slaughter,  but  whether  the 
animal  shall  be  kept  until  further  grown,  fattened,  or  slaugh- 
tered immediately  will  depend  upon  conditions. 


Hermaphroditism  157 

Forensically,  if  the  animal  has  been  sold  as  a  female,  the 
recognition  of  its  asexual  character  arouses  a  suspicion  of 
fraud,  but  by  no  means  proves  it  because,  as  previously 
stated,  single  births  are  sometimes  neuters,  though  possibly 
due  to  twin  conception,  the  other  twin  having  perished  and 
been  absorbed.  Ethically,  however,  the  result  is  the  same. 
The  animal  is  not  a  heifer  or  a  female.  Accordingly  it  has 
been  sold  for  what  it  is  not.  If  the  purchaser  has  paid  for 
a  breeding  female,  he  is  ethically  entitled  to  reimbursement. 

2.    Hermaphroditism 

Hermaphroditism,  in  which  organs  of  both  sexes  are 
found  in  one  individual,  is  observed  in  all  domestic  animals. 
Some  have  claimed  that  freemartins,  or  what  I  have  desig- 
nated as  "neuters",  are  in  fact  a  type  of  hermaphrodite, 
but  with  this  view  I  am  unable  to  agree.  Neuters,  as  they 
grade  up  toward  sexuality,  tend  always  toward  the  female 
— never  toward  the  male  or  toward  both.  Hermaphrodites 
incline  to  assume  prevailing  types  according  to  species. 

In  the  horse,  hermaphroditism  tends  generally  toward 
the  development  of  testicles  which  are  largely  retained 
within  the  abdomen  and  attached  and  located  the  same  as 
the  ovaries,  but  may  descend  into  an  imperfect  scrotum. 
The  vulva,  vagina,  and  uterus  may  develop  almost  per- 
fectly, as  in  one  case  occurring  in  my  clinic  where  the  vulva 
and  vagina  were  sufficiently  developed  that  I  castrated  the 
animal  through  the  vagina  in  the  same  manner  as  mares  are 
spayed.  The  rudimentary  penis,  or  enlarged  clitoris,  usu- 
ally ends  either  in  the  vulva  or  in  the  vicinity  of  the  ischial 
arch,  with  the  urethral  opening  directed  backward.  Some- 
times it  is  directed  backward  at  its  extremity.  The  mam- 
mae are  usually  moderately  developed  and  upon  casual  ex- 
amination, have  the  appearance  of  those  of  the  mare.  In 
one  case  upon  which  I  operated  there  were,  just  above  these 
rudimentary  glands,  small  scrotal  pouches  containing  the 
imperfectly  developed  testes. 

These  animals  present  chiefly  the  characters  of  the  crypt- 
orchid  horse  with  all  his  deranged  sexual  desire  and  ten- 


158 


Diseases  of  the  Genital  Organs 


dency  to  viciousness.  In  the  case  illustrated  by  Fig.  52,  the 
head,  neck,  voice,  and  disposition  were  those  of  a  cryptor- 
chid  horse,  and  the  vulva,  vagina,  uterus,  and  udder  were 
those  of  a  normal  mare.  The  erectile  organ  occupied  a  mid- 
dle place  between  the  clitoris  of  the  mare  and  the  penis  of 
the  horse. 

In  Fig.  51  is  shown  the  generative  apparatus  of  a  pig,  in 
which  the  hermaphroditism  is  of  quite  a  different  character ; 


T,  Testicle  ;  O 


Fig.  51 — Hermaphroditism.     Swine. 

ovary  ;  /'  penis  ;    UC,  uterine  curnu  ;    / ',  vas  deferens. 


one  of  the  glands  developed  into  a  typical  ovary  and  the 
other  into  a  testicle,  so  that  the  two  sides  of  the  genital  ap- 
paratus represented  the  two  sexes. 

Sections  of  these  genital  glands  show  one  to  be  a  typical 
cryptorchid  testicle  with  tubuli  seminiferi  and  the  other  a 
primitive  ovary  with  scattering  Graafian  follicles  contain- 
ing ova.  The  Muellerian  ducts  have  developed  into  typical 
oviducts,  uterus,  and  vagina.  From  the  Wolffian  ducts  have 
formed  typical  vasa  deferentia.  The  penis  is  normal  in 
form  and  extent. 


Hermaphroditism 


159 


i6o  Diseases  of  the  Genital  Orgayis 

I  have  found  no  records  of  fertility  in  hermaphrodites  of 
the  equine  or  other  species. 

B.  Arrests  in  the  Development  of  the  Male  Genitalia 

1.    Arrests  and  Aberrations  in  the  Development 
OF  THE  Testes 

Anorchidy,  or  complete  absence  of  the  testicles,  except  in 
neuters  as  described  above,  is  exceedingly  rare  in  domestic 
animals.  That  is,  if  some  other  portions  of  the  male  genital 
system  are  present  in  approximately  normal  development, 
the  testicles,  however  aberrant  or  arrested  in  development, 
are  regularly  present.  Anorchidy  is  repeatedly  mentioned 
in  veterinary  literature,  but  the  basis  for  the  assertion  is 
not  quite  clear.  I  have  observed  one  horse,  sold  as  a  colt 
for  breeding  purposes,  which  showed  no  testicles  or  scro- 
tum, had  no  sexual  desire,  and  lacked  the  form  and  voice  of 
the  stallion.  The  penis,  prepuce,  and  sheath  were  fully  de- 
veloped. Since  no  rectal  or  post-mortem  examination  was 
made,  a  positive  diagnosis  of  anorchidy  was  not  practicable. 
I  doubt  its  occurrence.  The  testis  is  so  fundamental  in  the 
genital  system  that,  in  its  absence,  I  am  inclined  to  doubt 
the  formation  of  such  accessories  as  penis,  prepuce  and 
sheath. 

Practical  anorchidy  does,  however,  occur,  as  in  the  horse 
just  described.  In  castrating  a  cryptorchid  colt,  the  hidden 
testis  was  represented  by  a  small,  calcareous  node,  render- 
ing him  to  all  practical  purposes  a  true  monorchid. 

2.    Cryptorchidy 

Cryptorchidy,  or  the  retention  of  one  or  both  testes  within 
the  abdominal  cavity,  is  common  in  domestic  animals.  It 
is  commonest  in  horses  and  boars.  As  a  rule — surely  in  98 
per  cent. — cryptorchidy  is  due  to  simple  arrest  in  develop- 
ment. Occasionally  a  dermoid  cyst  is  at  fault.  I  have  seen 
a  pig  in  which  the  cryptorchid  testicle  was  the  seat  of  ma- 
lignant growth.  These  new-growths  will  be  considered  un- 
der tumors  of  the  genitalia.  The  typical  cryptorchid  tes- 
ticle is  small,  soft,  and  fetal  in  type,  anatomically  and  his- 
tologically. 


Cn  'p  to  rch  idy  1 6 1 

The  cryptorchid  testis  does  not  produce  spermatozoa. 
When  one  testis  has  descended  into  the  scrotum,  it  under- 
goes compensatorial  hypertrophy  and  functions  freely. 
Monorchids,  though  the  scrotal  testicle  functions  freely,  are 
not  desirable  as  sires,  because  of  the  constant  peril  of  the 
transmission  of  the  defect  to  the  progeny.  The  condition 
is  beyond  remedy  in  a  breeding  sense,  since  the  involved 
testicle  can  not  be  induced  to  function. 

As  a  rule  of  practice,  cryptorchid  animals  designed  for 
meat  should  be  slaughtered  before  sex  maturity,  if  it  can  be 
done  economically.  If  desired  for  work  (horse)  or  as  a 
pet  (dog  or  cat)  or  if  it  is  to  be  grown  to  maturity  for  meat, 
castration  is  indicated.  In  all  domestic  animals,  cryptor- 
chidy  constantly  tends  to  produce  nymphomania.  The 
cryptorchid  horse  tends  strongly  to  become  dangerously 
vicious  when  four  or  five  years  old,  and  the  viciousness 
grows  with  years.  In  the  boar,  since  the  cryptorchid  tes- 
ticle, as  soon  as  the  animal  reaches  sex  maturity,  taints  the 
meat  beyond  endurance  for  human  food,  castration  is  essen- 
tial. The  operation  of  castration,  falling  within  the  do- 
main of  ordinary  surgery,  need  not  be  described  here. 

3.  Aberration  in  the  Position  of  the  Testis  in  the 

Scrotum 
In  one  case  I  have  observed  the  testicle  of  a  bull  caught  in 
its  descent  before  reaching  the  bottom  of  the  scrotum,  ap- 
parently because  the  gubernaculum  became  adherent  two  or 
three  inches  above  the  fundus  of  the  scrotum  or  because  of  a 
shortness  of  the  mesorchium.  The  result  was  that  the  testis 
tipped  forward  at  its  upper  end,  coming  to  rest  with  its 
long  axis  horizontal  instead  of  perpendicular.  Thus  it  lay 
in  the  same  position  as  the  testicle  of  the  horse.  The  tes- 
ticle appeared  in  every  respect  physiological.  It  was  of  the 
same  size  and  consistence  as  its  fellow.  The  bull  was  fer- 
tile.   No  interference  was  believed  desirable. 

4.  Arrest  in  Functional  Development  of  Scrotal 

Testes.    Fetal  Testis 
An  arrest  in  the  development  of  scrotal  testicles  some- 
times occurs,  in  which  they  fail  to  acquire  the  fundamental 


1 62  Diseases  of  the  Genital  Organs 

functional  power  of  secreting  spermatozoa.  When  the  tes- 
ticles descend  into  the  scrotum,  they  are  normal  in  size  and 
consistency.  As  the  age  of  sexual  function  approaches,  the 
testicles  fail  to  grow  to  full  size  and  remain  soft.  So  far  as 
I  have  observed,  the  sexual  desire  is  normal,  or  perhaps 
slightly  subnormal.  The  animal  mounts  the  female 
promptly  and  apparently  copulates  naturally.  Search  for 
spermatozoa  in  the  vagina,  immediately  following  copula- 
tion, is  negative.  Physical  examination  shows  the  testicles 
to  be  not  more  than  one-half  to  two-thirds  the  volume  of 
testes  of  normal  animals  of  the  same  age,  size,  and  breed. 
Even  more  marked,  in  my  experience,  is  the  soft,  flaccid 
character  of  the  glands.  In  all  cases  observed  by  me,  the  di- 
minutive, flaccid  testes  have  been  symmetrical  in  size  and 
form.  The  defect  appears  to  be  congenital  or  to  originate 
while  the  male  is  yet  a  nursling.  I  have  observed  it  only  in 
young  animals  which  were  absolutely  sterile  from  the  first. 
The  sterility  has  always  been  uniform  and  permanent.  At 
first  some  of  this  type  of  testicles  revealed  upon  histologic 
examination  what  was  looked  upon  as  a  true  arrest  in  devel- 
opment, like  the  typical  cryptorchid  testes.  Later,  in  some 
cases,  I  have  been  surprised  to  find  that  the  epithelium  of 
the  epididymal  tubules  has  been  destroyed  and  their  lumen 
filled  with  cell  debris  instead  of  spermatozoa,  the  semeni- 
ferous  tubules  have  largely  lost  their  epithelium,  spermato- 
zoa rare,  and  probably  at  no  time  viable.  This  leads  to  the 
conclusion  that  in  such  cases  the  condition  is  due  to  a  highly 
destructive  invasion  of  the  epididymis  and  testicle  by  an  in- 
fection which  falls  short  of  abscessation  or  suppuration  but 
absolutely  and  permanently  destroys  the  physiologic  func- 
tion of  the  organ.  The  condition  will  therefore  be  more 
fully  discussed  under  "Infections  of  the  Genital  Tract  of 
the  Bull." 

Forensically,  I  know  of  no  instance  which  has  been  de- 
cided in  a  law  court  in  case  of  sale.  The  sale  of  such  an  ani- 
mal for  breeding  purposes  is  rarely,  if  ever,  fraudulent. 
The  breeder,  selling  his  young  males  usually  without  having 
used  them  for  breeding  purposes,  does  not  discern  the  ster- 


Co7igcnital  Defects  of  the  Female  Genitalia  163 

ility  and  takes  no  note  of  the  diminutive  size  and  flaccidity 
of  the  testes.  Ethically,  the  buyer,  having  paid  for  a  breed- 
ing bull,  is  entitled  to  remuneration,  and  in  my  experience 
most  breeders  very  promptly  reimburse  the  buyer.  The 
condition  is  apparently  hopeless ;  no  form  of  handling  sug- 
gests itself. 

6.    Aberrations  in  the  Development  of  the  Penis 

In  rare  cases  aberrations  in  the  development  of  the  penis 
incapacitate  the  male  for  copulation.  I  attended  one  young 
bull  in  which  the  penis  was  somewhat  chisel-shaped  and  di- 
rected upward  when  protruded,  instead  of  being  acutely 
conical  and  directed  slightly  downward.  A  loose,  baggy 
fold  of  skin  about  the  umbilicus,  caught  by  the  penis, 
formed  a  pocket  in  which  the  glans  lodged  and  prevented 
copulation.  I  removed  a  transverse  gored  piece  of  skin, 
about  three  by  five  inches,  and  drew  the  wound  margins 
^together  by  sutures.  This  overcame  the  mechanical  diffi- 
culty. 

C.    Congenital  Defects  of  the  Female  Genitalia 

The  occurrence  of  asexual  individuals  and  the  impercep- 
tible gradations  between  the  neuter  and  the  female  have  al- 
ready been  described.  Independent  of  these,  brief  reference 
was  made  to  the  non-development  or  aberrant  development 
of  certain  portions  of  the  genital  system. 

The  failure  of  one  ovary  to  develop  and  function  is  ex- 
ceedingly rare,  except  in  conjunction  with  other  abnormali- 
ties. Usually  the  two  ovaries  are  not  equal  in  volume.  The 
greatest  disparity  in  size  is  seen  in  the  cow,  in  which  the 
left  is  almost  always  smaller  than  the  right,  frequently  less 
than  one-fourth  the  volume,  but  the  small  ovary  neverthe- 
less functions.  It  has  been  claimed  that  the  right  ovary  of 
the  cow  functions  far  more  frequently  than  the  left.  I  have 
the  abattoir  records  on  1700  pregnant  females,  of  which  55 
per  cent,  were  pregnant  in  the  right  horn  and  45  per  cent, 
in  the  left.  In  heifers,  especially  in  Channel  Island  breeds, 
which  regularly  have  very  small  ovaries,  the  left  gland  is 


164 


Diseases  of  the  Genital  Organs 


o  b 


■A  ■z 


Uterus  Unicornis  165 

frequently  no  more  than  one-quarter  inch  in  diameter,  but 
it  is  anatomically  perfect  and  of  the  adult  type.  Such  an 
ovary  functions.  I  recall  meeting  clinically  with  but  one 
ovary  of  fetal  type  where  the  corresponding  uterine  cornu 
was  developed;  this  ovary  was  paired  with  the  angio-car- 
cinoma  shown  in  Fig.  66.  In  most  cases  of  unicornual  uteri 
which  I  have  seen  the  ovary  was  of  normal,  adult  type  on 
the  side  where  the  uterine  horn  was  absent. 

The  absence  of  one  ovary,  or  the  fact  that  one  is  of  fetal 
type,  is  of  little  consequence  except  that  a  second  ovary 
serves  as  a  reserve  or  alternate.  So  long  as  one  good  ovary 
is  present  and  the  corresponding  oviduct  and  cornu  are 
physiologic,  the  animal  is  fertile. 

1.    Uterus  Unicornis 

Arrest  in  the  development  of  one  uterine  cornu  is  not 
rare  in  cattle.  In  the  abattoir  I  encountered  six  instances 
amongst  a  few  more  than  three  thousand  females— nearly 
two  per  thousand.  Five  of  them  were,  or  had  been,  preg- 
nant; one  was  a  heifer.  The  defect  is  apparently  of  little 
or  no  significance,  except,  as  in  the  ovaries,  the  second 
cornu  provides  a  reserve,  in  case  of  disaster  to  the  other 
side.  It  is  readily  recognized  by  rectal  palpation.  The 
single  horn  projects  directly  forward  from  the  anterior  end 
of  the  cervix.  No  uterine  body  is  recognizable.  In  the  ex- 
amination of  pure-bred  animals  for  sale,  the  unicornual 
uterus  should  be  classed  as  sound  but  defective,  and  the 
value  of  the  animal  as  a  breeder  somewhat  discounted. 

2.  Double  Uterus.    Double  Cervix 

Double  uterus  is  extremely  rare  in  domestic  animals.  I 
have  no  specimen  in  my  collection.  In  consultation  with  a 
colleague,  I  have  seen  one  cow,  which,  so  far  as  I  was  able 
to  determine  clinically,  had  two  complete  uteri  and  cer- 
vices but  there  may  have  been  a  communication  (uterine 
body)  at  the  anterior  end  of  the  two  cervical  canals.  The 
two  cervical  canals  were  perfect  and  readily  recognized. 
The  cow  was  fertile. 


1 66 


Diseases  of  the  Genital  Organs 


Fig.  54 — Cervix  of  a  Uterus  Unicornis. 
The  Cervix  is  partly  double.     OE,  Os  uteri  externum.     01,  Os  uteri  in- 
ternum.    CZ,,  Corpus  luteum  of  preifuancy.      U,  Uterus.     CC,  Cotyle- 
dons.    Between   OE  and   OI  the  cervix   is   greatly  distorted   and 
has  vagrant  partitions. 


I'u;.  55— Double  Cervix.     Cow. 
/,  /,  /,   Persistent  niedian    i)artition  of   Mueller's  ducts.      In   the  middle 
and  right  figures,  on  either  side  of  /,  are  the  cervices  containing  the  uterine 
seal   (of   pregnancy.)     2,   2,    Vaginal   wall     O,    (),   lips    of   os    uteri  exter- 
num :   O'  O'  false  median  lips  of  os  ut^ri. 


The  Persistence  of  Miiellermn  Ducts  167 

Double  cervix  is  not  at  all  rare.  My  collection  contains 
several  specimens,  each  having  individual  characteristics. 
It  is  interesting  to  record  that  a  double  cervix  is  occasion- 
ally associated  v^ith  a  one-horned  uterus. 

The  double  cervix  is  readily  diagnosed.  The  tv^o  cervices, 
lying  side  by  side,  have  the  normal  cervical  characters,  are 
sealed  in  pregnancy,  and  penetrable  with  a  sound  when  non- 
pregnant. The  condition  does  not  visibly  affect  fertility.  It 
is  objectionable  merely  as  a  congenital  defect  which  may  be 
perpetuated  and  accentuated  in  the  progeny. 

3.    Persistence  of  the  Median  Walls  of  the  Muellerian 
Ducts  in  the  Vagina 

Occasionally,  in  vaginal  palpation,  one  finds  a  perpendi- 
cular muscular  column  located  against  the  os  uteri  exter- 
num, but  free  from  its  lips,  which  extend  from  the  floor  to 
the  roof  of  the  vagina.  I  have  seen  the  structure  varying  in 
diameter  from  one-fourth  to  one  inch.  It  is  quite  firm  and 
covered  by  the  vaginal  mucosa.  It  serves  at  times  to  con- 
fuse the  inexperienced  veterinarian,  who,  by  recognizing 
the  OS  uteri  externum  first  on  the  right  and  then  on  the  left 
of  the  fleshy  column,  may  imagine  that  he  is  dealing  with  a 
double  cervix.  The  defect  is  easily  diagnosed.  The  operator 
can  pass  his  finger  across  between  the  vaginal  end  of  the 
cervix  and  the  fleshy  cord  and,  by  bending  the  finger,  com- 
pletely encircle  the  column.  By  exerting  traction  the  mus- 
cular column  can  usually  be  drawn  back  into  the  vulva, 
where  it  can  be  clearly  seen. 

Ordinarily  the  structure  does  not  interfere  with  concep- 
tion. In  some  cases  the  structure  seemed  to  me  competent 
to  cause  difficulty  in  parturition  because  one  of  the  ex- 
tremities might  pass  on  one  side  of  the  cord  and  one  on  the 
other  side.  Then  the  column  would  need  to  rupture  or  be 
cut  before  parturition  could  be  completed.  After  parturi- 
tion, the  fetal  membranes  might  very  well  become  caught 
and  detained  by  portions  passing  on  either  side.  There- 
fore it  is  desirable  to  sever  the  column.  I  have  hooked  an 
index  finger  about  the  cord,  drawn  it  well  back,  and  then 


[68 


Diseases  of  the  Genital  Orgayis 


I'lGS.  56,  57— Persistent  Median  Walls  of  Mueller's  Ducts. 
I'-i^.  56  (above).  View  of  eervi.x  t'roiii  \'a.«;in;i.  'iMie  i)ersisteiil  wall,  /, 
gives  an  a])pearance  of  a  double  oervi\  wliicli  Imj;  57  (below)  shows,  in 
horizontal  section,  is  fal.se.  The  depression  on  the  ri>;ht  is  the  inouth  of  the 
sin<(le  cervix,  while  that  on  the  left  con.stitutes  a  cul-de-sac  Had  the  open- 
ing on  the  left  joined  the  true  cervical  caiuil,  just  in  front  of  /,  it  would 
have  left  the  usual  perdendicular  muscular  column.  Had  the  persistent 
partition  exteniled  to  the  uterine  cavity,  l\  a  double  cervix  would  have  re- 
sulted.     C,  I'alse  OS  uteri.      C ,  True  os  uteris 


Persistent  Hymen  169 

severed  it  with  a  scalpel  or  with  scissors.  An  insignificant 
hemorrhage  follows.  There  is  virtually  no  sensation  in  the 
structure  and  no  material  evidence  of  pain  when  it  is 
severed. 

4.    Persistent  Hymen 

In  the  development  of  the  female  embryo  of  cattle,  the 
hymen  regularly  disappears  as  a  complete  membrane,  but  a 
series  of  fragmentary  projections  remains,  marking  the 
vulvo-vaginal  boundary  line.  Upon  the  floor  of  the  genital 
passage  this  line  is  located  just  in  front  (the  ovarian  side) 
of  the  urethral  opening.  The  vestiges  of  the  hymen  consti- 
tute a  well  defined  stricture  between  the  vulva  and  the  va- 
gina. In  the  manual  examination  of  heifers,  passing  this 
stricture  with  the  hand  frequently  causes  a  slight  tearing 
accompanied  by  hemorrhage.  In  numerous  cases,  remnants 
of  the  hymen  persist  as  fleshy  cords,  sometimes  the  dimen- 
sions of  a  lead  pencil,  extending  perpendicularly  from  the 
floor  to  the  roof  of  the  passage,  sometimes  on  the  median 
line,  but  generally  to  the  right  or  left  of  the  centre.  Sel- 
dom, if  ever,  do  they  cause  difficulty  of  any  consequence, 
but  they  should  be  cut  or  ruptured  when  encountered. 

Rarely,  the  hymeneal  constriction  forms  a  slight  cul-de- 
sac  in  the  vaginal  floor,  where  debris  accumulates  and  de- 
composes, to  imperil  conception.  Sometimes  the  cul-de-sac 
may  be  overcome  by  dividing  the  stricture  along  the  floor. 
Otherwise,  the  peril  is  to  be  obviated  by  frequent  vaginal 
douches  until  conception  occurs.  Parturition  will  ordinarily 
eliminate  the  defect. 

The  hymen  sometimes  persists  as  an  imperforate  mem- 
brane. I  have  observed  but  two  cases,  one  in  a  heifer,  the 
other  in  a  ewe.  In  Great  Britain,  I  am  told,  it  is  common  in 
a  certain  strain  of  white  cattle,  so  that  it  has  become  known 
as  "the  white  heifer  disease".  I  have  been  unable  to  get 
particulars  about  it.  In  any  animal,  imperforate  hymen  in- 
evitably leads  to  the  accumulation  of  menstrual  and  other 
debris  in  the  vagina,  which  becomes  a  great  retention  cyst. 
Estrum  may  be  regular,  but  copulation  is  impossible,  be- 
cause the  penis  of  the  male  is  prevented  from  entering  the 


170  Diseases  of  the  Genital  Organs 

vagina.  As  soon  as  the  vagina  becomes  fully  distended, 
discomfort  and  pain  result,  causing  colicky  symptoms  and 
expulsive  efforts.  During  the  expulsive  efforts  the  hymen 
may  be  forced  back  into  the  vulva  and  become  visible  be- 
tween the  vulvar  lips.  Palpation  reveals  a  tense,  mem- 
branous wall  retaining  a  liquid  beyond.  On  the  floor  of  the 
passage,  the  membrane  is  attached  just  anterior  to  (on  the 
ovarian  side  of)  the  meatus  urinarius.  The  attachment  of 
the  membrane  to  the  walls  can  be  traced  completely  around 
the  genital  passage.  Per  rectum,  the  vagina  is  readily  pal- 
pable as  an  elongated  sac  firmly  distended  with  fluid.  In 
the  one  heifer  which  I  observed,  both  uterus  and  vagina 
were  distended  greatly  with  thin  pus.  This  caused  much 
pain,  with  constant  straining  and  loss  of  flesh.  It  is  quite 
probable  that  the  infection  was  carried  to  the  genital  tract 
by  the  blood  early  in  the  heifer's  life  and  remained  dormant 
until  menstrual  debris  collected,  when  suppuration  promptly 
ensued.  The  handling  consists  of  the  surgical  destruction 
of  the  membrane,  which  should  be  punctured  approximately 
in  the  center  with  a  scalpel  and  the  opening  thus  made  ex- 
tended by  cutting  or  tearing  to  a  sufficient  degree.  It  is 
especially  important  to  extend  the  opening  in  the  membrane 
downward  to  the  floor  of  the  passage,  since  otherwise  it 
may  serve  to  form  a  cul-de-sac  leading  to  the  retention  and 
decomposition  of  discharges,  thus  keeping  a  pool  of  in- 
fected debris  about  the  os  uteri  externum,  interfering  with 
conception. 

When  persistent  hymen  becomes  a  race  characteristic,  as 
in  the  "white  heifer  disease"  of  England,  it  would  appear 
best  to  eliminate  the  defect  by  careful  selection. 

Imperforate  hymen  in  the  mare  is  apparently  very  rare. 
There  occur  a  few  rather  vague  descriptions  of  imperforate 
hymen  in  the  mare  from  which  the  actual  facts  are  unob- 
tainable. There  occur  in  literature  statements  that  in  the 
pregnant  heifer  and  filly  imperforate  hymen  may  exist  at 
the  time  of  parturition.  Evidently  that  is  impossible.  A 
remnant  of  the  hymen  sufficient  to  complicate  parturition 
may  persist,  but  copulation  cannot  occur  and  leave  the  mem- 
brane imperforate.     When  imperforate,  a  distension  of  the 


Persistent  Hymen  17  r 

vagina  with  menstrual  debris  is  inevitable.  So  far  as  I 
have  observed,  the  imperforate  hymen  can  not  be  ruptured 
by  the  male.  It  is  imperforate  and  persistent  because  ab- 
normally thick  and  tough. 

I  have  observed  in  a  filly  a  persistence  of  the  lower  por- 
tion of  the  hymen,  constituting  a  cul-de-sac  which  ended  at 
the  anterior  margin  of  the  urethra  and  sloped  upward  and 
backward  as  a  crescent-shaped  partition  open  at  the  top. 
It  was  attempted  to  breed  her  to  a  very  large  stallion.  After 
several  unsuccessful  efforts  my  advice  was  sought. 

Upon  introducing  my  hand,  I  promptly  encountered  a 
broad  band  stretched  transversely  and  sloping  forward  and 
downward.  Pushing  my  hand  along  the  lower  surface  of 
the  membranous  partition,  I  found  that  the  urethral  open- 
ing formed  the  fundus  of  a  great  cul-de-sac.  The  urethra 
was  so  greatly  dilated  that  it  readily  admitted  my  hand. 
Apparently  it  had  been  dilated  by  the  penis  of  the  stallion. 
Searching  higher  up,  I  found  the  hymen  was  not  imperfor- 
ate; there  was  a  large  opening  at  the  vaginal  roof.  The 
groom  was  advised  to  be  on  the  alert  at  the  next  effort  at 
coitus  and  push  the  penis  of  the  stallion  upward  just  at  it 
entered  the  vulva.    The  filly  conceived. 

The  case  reports  of  persistent  hymen  which  have  inter- 
fered with  parturition  are  probably  largely  based  upon  di- 
agnostic error.  Instead  of  persistent  hymen  there  was 
probably  a  persistent  portion  of  the  median  walls  of  the 
ducts  of  Mueller,  a  condition  just  short  of  a  double  vagina. 
Such  remnant  is  resistant  enough  to  readily  cause  dystocia. 
Many  appear  to  think  erroneously  of  any  band  passing 
across  the  vagina  as  "persistent  hymen".  The  persistent 
median  wall  is  far  more  common  than  the  persistent  hymen. 
The  condition  has  been  discussed  above. 

The  persistent  hymen  which  is  perforate  usually  has  but 
little  significance.  The  imperforate  hymen  has  little  peril 
for  the  life  and  general  health  of  the  patient  unless  over- 
looked until  the  vagina  is  tensely  filled  with  menstrual  de- 
bris. When,  as  in  the  heifer  described  above,  both  vagina 
and  uterus  are  greatly  distended  with  pus,  there  is  ground 
for  serious  fear  that  breeding  life  is  at  an  end. 


Chapter  V 

MISCELLANEOUS  DEFECTS  AND  DISEASES 
INTERFERING  WITH  FERTILITY 

There  are  many  defects  and  diseases  of  other  than  the 
genital  organs  which  may  render  coitus  physically  difficult 
or  impossible,  although  the  animal  is  fundamentally  fertile. 

Much  has  been  said  of  the  physical  difficulty  of  coitus  be- 
tween individuals  representing  extremes  in  size.  This  oc- 
curs only  when  the  disparity  in  size  is  so  great  that  mating 
is  as  a  rule  imprudent  for  other  reasons.  Extreme  varia- 
tion in  size  may  render  coitus  difficult  or  dangerous.  In 
both  horses  and  cattle  it  is  not  rare  to  observe  successful 
coitus  of  a  large  male  with  a  female  30  to  40  per  cent,  of 
his  weight.  The  danger  from  such  disparity  is  not  great, 
but  when  a  stallion  has  an  extra  large  penis  this  may  have 
great  peril  for  the  vagina  of  the  mare.  These  injuries  will 
be  discussed  later.  When  a  very  small  male  attempts  coitus 
with  a  large  female,  failure  is  dependent  ordinarily  upon 
the  shortness  of  the  hind  legs  of  the  male,  making  it  impossi- 
ble for  him  to  reach  the  vulva.  As  a  rule,  however,  the  male 
of  a  given  breed  of  animals  is  able,  not  long  after  he  reaches 
puberty,  to  copulate  with  an  adult  female  of  his  breed.  In 
horses  and  dogs,  where  giant  and  pigmy  breeds  have  been 
developed,  coitus  between  these  extremes  is  virtually  im- 
possible. The  variations  in  weight  between  Clydesdale 
horses  and  Shetland  ponies,  for  instance,  may  be  from  2400 
to  200  pounds — or  12  to  1,  In  dogs  the  extremes  reach 
nearly  100  to  1,  Disparity  in  size  does  not  enter  prominently 
into  the  question  of  the  physical  possibility  of  copulating. 

A.    Umbilic  Hernia 

Umbilic  hernia,  especially  in  the  bull,  whenever  of  ma- 
terial size,  inhibits  copulation  by  deflecting  the  penis  as  it 
is  being  protruded.    The  defect  is  ordinarily  not  brought  to 


Umbilic  Hernia  173 

the  attention  of  the  veterinarian,  except  in  young  bulls  of 
high  pedigree.  If  the  bull  is  an  ordinary  grade,  or  of  low 
pedigree,  he  is  usually,  and  quite  properly,  sent  to  slaughter. 
However,  when  a  bull  is  of  high  pedigree  and  potentially  of 
great  value,  the  owner  often  becomes  anxious  to  have  the 
difficulty  overcome  by  surgical  interference. 

Umbilic  hernia  is  a  congenital  defect  due  to  an  arrest  in 
the  normal  closure  of  the  umbilic  ring.  As  an  arrest  in 
fetal  development,  it  has  the  same  significance  for  the  breed 
or  family  as  other  teratological  defects.  It  signifies  a  fun- 
damental organic  weakness  always  threatening  to  be  trans- 
mitted to  the  progeny.  Umbilic  hernia  is  very  difficult  to 
handle  in  the  bull.  The  breeder  usually  defers  the  operation 
until  the  rumen  has  attained  a  great  weight.  Then  the  sur- 
geon is  faced  with  a  weight,  which  it  is  virtually  impossible 
to  support  by  means  of  surgical  appliances,  bearing  imme- 
diately upon  the  operative  area.  In  umbilic  hernia  of  the 
bull,  the  surgeon  is  denied  his  chief  mechanical  means  of 
support — the  bandage — because  the  opening  of  the  sheath 
is  immediately  at  the  umbilicus,  so  that  the  bandage  can  not 
be  eff'ectively  applied  without  involving  and  obstructing  the 
sheath  opening.  As  a  result,  when  attempting  to  suture  an 
umbilic  hernia  in  a  bull,  the  bandage  must  be  omitted  or  in- 
effectually applied,  and  before  healing  occurs  the  sutures 
usually  tear  away  and  carry  with  them  portions  of  the  her- 
nial ring,  making  the  opening  larger  than  before.  If  the 
surgeon  undertakes  to  clamp  or  ligate  the  hernial  sac,  by 
the  time  the  incarcerated  mass  has  sloughed  away,  the  pres- 
sure from  above  has  stretched  the  tissues  and  formed  a 
new  sac.  If  the  hernia  is  operated  on  when  the  calf  is  but  a 
few  days  old,  before  the  viscera  acquire  insupportable 
weight,  the  surgeon  may  more  readily  succeed.  Even  then, 
however,  the  fundamental  weakness  of  structure  is  there, 
and  in  my  judgment  the  animal  should  not  be  used  as  a 
sire. 


174 


Diseases  of  tlie  Genital  Orgayis 

B.    Ventral  Hernia 


Large  ventral  herniae,  such  as  indicated  in  Fig.  58,  also 
inhibit  copulation,  rendering  the  bull  worthless  as  a  sire. 


Fig.  58 — Large  Ventral  Hernia  preventing  Coitus. 

C.  Horizontal  Vulva 

Horizontal  vulva  in  the  cow  sometimes  serves  to  render 
copulation  difficult  or  impossible.  In  aged  cows  with  pen- 
dulous abdomen  and  low  back  (lordosis,  or  sway-back)  the 
superior  commissure  of  the  vulva  is  depressed  and  dragged 
downward  and  forward  by  the  descent  of  the  rectum  and 
anus,  so  that  the  vulvar  opening  is  directed  upward.  More 
rarely,  the  vulvar  opening  is  directed  upward  in  otherwise 
well-formed  heifers,  as  a  peculiarity  in  conformation.  When 
the  bull  attempts  to  copulate  with  such  an  animal,  the  penis 
tends  to  glide  over  the  vulva  and  strike  against  the  anal  re- 
gion. This  is  best  avoided  by  causing  the  female  to  stand 
with  her  hind  feet  in  a  pit  or  depression,  with  the  fore  feet 


Strictures  of  Vagitia  ajid  Vulva  175 

high,  thus  bringing  the  vulvar  opening  toward  the  perpen- 
dicular. Horizontal  vulva  also  follows  perineal  laceration 
at  the  superior  vulvar  commissure.  This  is  described  under 
"Parturient  Injuries". 

D.    Strictures  of  Vagina  and  Vulva 

Strictures  of  the  vagina,  and  more  rarely  of  the  vulva, 
are  occasionally  encountered  in  domestic  animals,  chiefly 
in  the  mare  and  the  cow.  They  always  result,  so  far  as 
known,  from  some  prior  inflammation  of  these  parts,  but 
frequently  the  history  of  the  disease  is  not  available  and  the 
veterinarian  encounters  simply  the  result  of  the  disease. 

In  a  mare  which  came  under  my  observation,  there  was 
difficulty  in  parturition  due  to  an  anterior  presentation  in 
the  dorso-sacral  position,  with  the  two  hind  feet  pushed 
forward  beneath  the  fold  into  the  pelvis.  The  difficulty,  oc- 
curring during  the  night,  was  not  observed  until  mxorning. 
Delivery  was  promptly  and  readily  accomplished  by  em- 
bryotomy, but  the  vulva  had  been  so  badly  contused  that 
more  than  half  of  its  circumference  became  necrotic  and 
sloughed  away.  The  resulting  constriction  was  such  that 
the  animal  could  not  copulate.  She  might  have  been  arti- 
ficially fertilized  without  material  difficulty  but,  as  she  prob- 
ably would  have  been  unable  to  give  birth  to  young,  no  at- 
tempt was  made  to  cause  her  to  breed.  I  could  see  no  pros- 
pect for  success  by  any  operation.  The  mare  was  conse- 
quently used  for  work. 

I  observed  one  instance  of  severe  stricture  of  the  vagina 
in  a  mare,  the  origin  of  which  was  unknown.  Without 
knowledge  of  the  presence  of  the  lesion,  the  owner  attempted 
to  breed  her.  This  caused  extensive  lacerations  of  the  va- 
gina with  great  pain  and  straining.  She  was  placed  under 
my  care.  The  straining  caused  an  eversion  of  the  floor  of 
the  vagina  and  the  urinary  bladder  (vesico-vaginocele) .  I 
attempted  to  keep  the  vagina  and  bladder  in  position  with  a 
truss,  and  later  with  vulvar  sutures,  but  failed.  Finally  I 
controlled  the  straining  and  eversion  by  producing  profound 
and  prolonged  chloral  narcosis. 


176  Diseases  of  the  Genital  Organs 

Stricture  of  the  vagina  in  the  cow  is  comparatively  com- 
mon and  of  varying  degrees.  Occasionally  one  meets  cases 
in  which  it  is  impossible  to  reach  the  cervix.  Frequently 
the  stricture  is  associated  with  long-standing  sterility, 
where  it  is  highly  desirable  to  reach  the  cervix  and  handle 
the  uterus. 

In  my  experience,  stricture  of  the  vagina  has  occurred 
most  frequently  in  herds  where  the  vagina  has  been  douched 
with  potassium  permanganate.  It  is  not  certain  that  there 
is  any  connection  between  the  potassium  permanganate 
douching  and  the  stricture.  Stricture  is  very  liable  to  fol- 
low douching  with  any  powerful  antiseptic,  and  very  natu- 
rally might  follow  the  use  of  a  too  highly  concentrated  per- 
manganate solution.  There  is  another  possibility  with  the 
potassium  permanganate.  As  it  is  very  heavy  and  dissolves 
rather  slowly,  laymen  or  careless  veterinarians  may  inad- 
vertently introduce  some  crystals  into  the  vagina.  The 
liquid  would  be  largely  thrown  out,  and  the  heavy  crystals 
remain  behind.  These  would  cause  profound  irritation  with 
necrosis  of  the  mucosa  and  stricture  would  naturally  follow. 
Stricture  is  likely  to  follow  any  case  of  severe  vaginitis,  re- 
gardless of  the  cause. 

If  the  stricture  is  not  too  severe,  the  prognosis  is  good. 
If  the  condition  of  the  vagina  is  such  that  copulation  may 
be  safely  performed  and  there  is  not  too  great  hardening, 
the  vagina  may  largely  recover  its  normal  elasticity  during 
the  rest  of  pregnancy,  so  that  the  animal  may  go  through 
parturition  safely.  If  the  uterus  requires  handling,  it  may 
be  possible  to  pass  the  uterine  forceps  through  the  stricture 
and  grasp  the  cervix  without  inserting  the  hand,  or  the  for- 
ceps may  be  guided  with  one  hand  in  the  rectum.  In  other 
cases,  one  may  be  able  to  introduce  the  vaginal  dilator  (Fig. 
37)  and  distend  the  passage  sufficiently  that  the  cervix  may 
be  seen  and  grasped.  Whenever  I  have  been  able  to  grasp 
the  cervix,  it  has  been  possible  to  draw  it  out  through  the 
constricted  vagina  and  give  to  the  cervix  and  uterus  any  at- 
tention desired. 


Diseases  of  the  Feet  and  Lijubs 

E.    Diseases  of  the  Feet  and  Limbs 


.177 


Breeding  bulls  and,  to  a  lesser  degree,  cows  which  are 
kept  constantly  stabled  tend  to  become  disabled  owing  to 
the  fact  that  the  growth  of  the  hoofs  is  not  counterbalanced 
by  the  normal  wear  of  travel.  The  margins  of  the  lateral 
and  median  walls  tend  to  converge  and,  as  they  become  elon- 
gated, to  bend  beneath,  the  soles,  approaching  each  other  as 


Fig.  59  -Overgrown  Hoofs  interfering  with  Coitus.     Bull. 
S,  Sole,  which  has  been  largely  over<,rro\vii  by  the  wall,    M\  growing  for- 
ward from  the  heel.     /,  A  shallow  groove  showing  approximately  the 
normal  location  of  the  margin  of  the  wall. 
12 


lyS  Diseases  of  the  Genital  Organs 

shown  in  Fig.  59.  The  heel  portion  of  the  wall  is  directed 
acutely  downward  and  forward,  and,  as  this  is  not  worn 
away  by  the  idle  animal,  the  superposed  weight  bends  the 
free  margin  forward  and  inward  until  it  lies  flat  against 
the  sole,  and  continues  to  grow  forward  until  the  posterior, 
or  heel  wall  finally  reaches  the  toe,  completely  covering  the 
sole.  The  bull  then  walks  upon  the  elongated  heel  wall,  be- 
tween which  and  the  sole  is  a  space,  opening  at  the  toe,  in 
which  gravel,  dirt,  etc.,  become  impacted.  Then  follows  un- 
equal pressure  (by  gravel,  etc.)  upon  the  sole,  contusions 
of  the  sensitive  parts,  pressure  necrosis,  and  other  lesions. 
The  bull  soon  becomes  lame,  and,  unless  the  difficulty  is 
promptly  recognized,  may  be  crippled  permanently.  Fre- 
quently I  have  seen  bulls  rendered  incapable  of  copulation 
from  this  cause.  The  condition  is  best  prevented  by  care- 
fully trimming  the  feet  of  all  breeding  bulls  kept  in  stan- 
chions or  stalls,  at  least  twice  annually.  Once  the  difficulty 
has  become  established,  the  walls  are  permanently  deformed 
and  constantly  turn  in.  Then  the  trouble  can  be  palliated 
only  by  the  frequent  trimming  of  the  feet  and  by  keeping 
the  bull  well  bedded  on  a  clay  or  board  floor.  Stone,  con- 
crete and  gravel  floors  should  be  avoided. 

The  trimming  of  the  feet  may  generally  be  accomplished 
with  hoof-cutting  pincers,  with  the  animal  standing.  When 
the  bull  is  secured  in  a  stanchion,  two  strong  men  can  gen- 
erally hold  up  one  of  his  hind  feet  and  extend  it  backward 
while  the  opierator  trims  it.  The  men  should  take  a  stout, 
smooth  beam,  preferably  a  round  piece  about  six  feet  long, 
pass  it  between  the  hind  legs  in  front  of  the  tarsus  of  the 
foot  to  be  raised,  and,  firmly  grasping  each  end  of  the  beam, 
lift  it  upward  and  draw  it  sharply  backward,  so  that  the 
flexure  of  the  hock  rests  upon  the  middle  of  the  beam. 
Most  animals  will  struggle  but  little  and  the  trimming  of 
the  hoof  can  be  performed  readily.  If  the  animal  is  too  re- 
sistant, he  should  be  cast  and  secured  the  same  as  already 
recommended  for  examining  the  penis. 

Painful  diseases  of  the  posterior  feet  and  limbs  occa- 
sionally render  a  male  incompetent  or  umvilling  to  niomit 


Diseases  of  the  Feet  and  Limbs  179 

the  female,  thus  throwing  increased  weight  upon  his  hind 
limbs.  Obviously  any  attempt  at  copulation  aggravates  the 
local  disease.  The  male  should,  therefore,  be  held  out  of 
breeding  until  he  has  recovered.  Sometimes  it  is  wished 
to  breed  a  female  suffering  from  some  local,  non-genital 
disease  which  renders  copulation  difficult  or  dangerous  for 
her  because  of  the  weight  of  the  male  which  she  is  called 
upon  to  bear.  Partial  relief  from  the  excessive  weight  may 
be  secured  in  cows  and  mares  by  using  a  breeding  rack  so 
constructed  that  the  female  stands  between  two  broad, 
sloping  shelves  of  such  height  that,  when  the  male  mounts 
her,  his  fore  feet  rest  upon  the  shelves  and  his  weight  is 
more  or  less  completely  borne  by  these.  The  shelves  must 
fit  closely  against  the  sides  of  the  female,  in  order  to  ob- 
viate the  danger  of  the  male's  getting  his  foot  between  the 
shelf  and  the  female,  and  should  slope  downward  from  the 
head  of  the  female.  The  breeding  rack  does  more  than 
partly  or  wholly  support  the  weight  of  the  male.  When  it 
fits  closely  and  a  beam  is  placed  securely  in  front  of  her 
sternum,  her  equilibrium  is  maintained  and  she  can  sup- 
port without  increased  danger  probably  twice  the  weight  of 
which  she  would  be  capable  otherwise.  This  is  especially 
true  of  the  violent  copulatory  thrust  of  the  bull.  Not  in- 
frequently, when  a  cow  is  weakened  and  unsteady,  or  when 
a  small  heifer  is  mounted  by  a  large  bull,  the  thrust  causes 
the  cow  or  heifer  to  crumple  up  and  fall  headlong. 

It  is  unwise  to  breed  a  crippled  or  weak  female  unless  it 
can  be  reasonably  determined  that  the  patient  will  promptly 
recover  from  the  local  disease.  Otherwise,  as  soon  as  the 
increased  weight  of  pregnancy  has  to  be  borne  by  the  weak 
member,  a  new  peril  is  encountered  in  the  aggravation  of 
the  disease.  Pregnancy  may  occur  and  parturition  may  be 
safely  passed,  but  the  progeny  is  rarely  well  nourished  or 
valuable. 

F.    Paralysis  and  Plumbism 

Paralysis  sufficient  to  interfere  with  copulation  may  oc- 
cur in  any  animal,  and  from  a  great  variety  of  causes.     In 


i8o  Diseases  of  the  Genital  Organs 

the  stallion  there  occurs  sometimes  a  paralysis  of  the  pos- 
terior limbs.  In  one  bull  in  my  experiment  herd,  paralysis 
was  due  to  lead  poisoning  caused  by  licking  a  painted  board 
when  but  a  few  days  old.  He  was  completely  paralyzed 
and  unconscious  for  a  number  of  days.  For  months  he  was 
quite  severely  paralyzed  in  his  posterior  parts,  with  some 
swelling  of  the  joints  and  bones.  He  attained  medium  size, 
and  was  normally  fertile,  but  was  quite  awkward  and  copu- 
lated with  some  difficulty. 

Stallions  suffer  occasionally  from  paralysis  of  the  penis, 
the  cause  of  which  is  generally  unknown,  largely  associated 
with  partial  paralysis  of  the  posterior  limbs  and  not  ordi- 
narily subject  to  remedy. 

G.    Torsion  of  the  Testicle 

Torsion  of  the  spermatic  cord,  it  is  claimed,  sometimes 
causes  atrophy  of  the  testicles  and  inhibits  the  formation 
of  spermatozoa  because  of  interruption  of  the  nutritive  sup- 
ply. It  is  well  known  that  emasculation  can  be  produced  in 
ruminants  by  the  process  designated  double  subcutaneous 
torsion,  in  which  the  testicles  are  twisted  and  inverted  in 
such  a  manner  as  to  interrupt  their  vascular  supply  and  in- 
duce atrophy,  with  disappearance  of  sexual  desire  and 
power. 

Occasionally  in  man  torsion  of  the  testicle  appears  to  pro- 
duce painful  and  serious  symptoms  simulating  incarcerated 
hernia  with  vomition.  O'Connor (')  describes  two  cases 
and  states  that  one  hundred  twenty-four  cases  have  been 
recorded  in  man.  I  am  not  aware  that  disease  has  been 
traced  to  torsion  of  the  spermatic  cord  in  animals.  In  the 
stallion,  with  horizontal  testes,  the  gland  is  frequently  re- 
volved upon  its  transverse  axis  through  180  degrees,  but 
this  appears  to  be  of  no  consequence.  The  horizontal  posi- 
tion of  the  testicle  permits  it  to  revolve  upon  its  transverse 
axis  below  the  mesorchium.  The  displacement  involves 
very  slight  damage  to  the  spermatic  cord.    The  freedom  of 

'Vincent  J.  O'Connor,  Torsion   of   the   Spermatic  Conl.  Surg.   Gyii.  and 
Obst.,  Dec,  1919,  !>.  5S0. 


Torsion  of  the    Testicle  i8i 

the  spermatic  cord  in  the  inguinal  canal  permits  part  of  the 
torsion  to  occur  within  the  abdomen,  so  that  the  twist  need 
not  be  great  at  any  one  point.  In  man  the  torsion  is  said 
to  occur  frequently  where  the  gland  is  caught  in  the  inguinal 
canal.  Just  how  it  can  revolve  in  the  inguinal  canal,  I  fail 
to  understand.  Inguinal  cryptorchidy  is  familiar  to  veteri- 
narians, but  torsion  is  rarely,  if  ever,  recognized  in  these 
cases.  I  have  observed  but  one  instance  of  torsion  which 
was  of  consequence.  In  an  adult  cryptorchid  presented  for 
castration,  I  quickly  recognized  a  state  of  affairs  new  to 
me,  finally  recognized  what  I  believed  to  be  the  vas  deferens, 
traced  this  to  what  appeared  to  be  the  testicle,  and  then  ap- 
plied traction  in  an  effort  to  bring  the  gland  out  through  the 
wound.  Finally  an  attachment  unexpectedly  parted,  and  a 
large,  livid-colored  testicle  was  brought  out.  The  spermatic 
cord  was  spiral,  the  circulation  had  been  barred,  and  the 
cord  and  testicle  were  necrotic.  The  cord  was  so  weakened 
at  the  chief  point  of  torsion  that  it  gave  way  at  that  point. 
O'Connor,  cited  above,  believes  the  chief  cause  of  torsion  to 
be  the  irregular  contraction  of  muscle  bundles  in  the  cre- 
master,  but,  in  my  case  with  the  testicle  in  the  abdomen, 
such  an  explanation  can  not  be  accepted,  as  the  cremaster 
does  not  come  into  play  or  become  visibly  developed  until 
the  testicle  descends  into  the  scrotum.  A  study  of  Fig.  1 
will  show  how  a  cryptorchid  testicle  could  readily  revolve 
upon  its  transverse  axis.  The  testicle  of  the  ruminant, 
moored  throughout  by  the  mesorchium  to  the  wall  of  the 
scrotum,  can  not  possibly,  so  far  as  I  can  see,  revolve  upon 
either  of  its  axes.  The  possibility  of  serious  torsion  of  the 
spermatic  cord  should  be  borne  in  mind. 

H.    Traumatic  Orchitis 

According  to  many  veterinary  authors,  orchitis  in  animals 
is  due  largely  to  traumatism.  Professor  Hendricks'  empha- 
sizes the  belief  in  trauma  as  a  cause  of  orchitis  and  considers 
that  most  cases  of  inflammation  of  the  testicles  are  due  to 
mechanical  injuries.     It  is  an  open  question,  however,  to 

iHandbuch  der  tierartzl.     Chirurgie  u.   Geburtshilfe,  III  Band. 


1 82  Diseases  of  the  Genital  Organs 

what  extent  such  an  opinion  is  based  on  experience  and  to 
what  extent,  upon  legend.  Personally  I  have  not  observed 
orchitis  in  any  domestic  animal  where  it  was  plainly  due  to 
traumatism  except  in  one  instance  of  an  abattoir  bull  which 
had  suffered  from  gunshot  wound  in  the  scrotum,  two  of  the 
shot  having  lodged,  one  in  the  epididymis  and  the  other  in 
the  testicle.    This  case  is  illustrated  in  Fig.  59a. 

Cinically  orchitis  is  most  common  in  the  stallion,  in  which 
animal  the  testicles  are  unusually  well  protected  against 
traumatism  when  compared  with  those  of  other  domestic 
animals.  The  pendent  testicles  of  ruminants  are  exposed 
preeminently  to  mechanical  injury.  In  the  ram  and  the  he- 
goat,  the  testicles  hang  so  low  that  in  moving  rapidly  over 
rough  ground,  especially  where  there  are  stumps  and  high- 
projecting  stones,  the  testicles  frequently  come  in  rather  vio- 
lent contact  with  these  foreign  objects.  In  all  ruminants 
the  pendent  testicles  are  thrown  against  the  thighs  repeat- 
edly whenever  the  animal  is  in  rapid  locomotion,  and  yet  I 
have  not  observed  orchitis  as  a  result  of  this.  In  trotting 
stallions  there  is  a  general  belief  that,  unless  a  suspensorium 
is  used,  orchitis  may  result  from  the  constant  striking  of 
the  testicles  against  the  thighs  during  rapid  locomotion, 
but  I  find  nothing  in  veterinary  literature  to  indicate  that 
orchitis  arises  in  this  way. 

While  it  must  be  freely  admitted  that  orchitis  may  arise 
in  any  animal  because  of  traumatism,  careful  clinical  ex- 
amination would  indicate  that  the  affection  is  very  rare. 
It  is  difficult  to  determine  clearly  just  what  type  of  orchitis 
a  mechanical  injury  may  induce.  It  cannot  by  any  con- 
ceivable means  cause  an  abscess  of  the  testicle  unless  there 
is  first  a  destructive  injury  to  the  skin  or  a  penetrant  wound 
so  that  the  trauma  serves  merely  to  open  an  avenue  of  in- 
fection rather  than  to  directly  cause  orchitis.  In  Chapter 
XIV  of  this  treatise,  the  question  of  orchitis  as  a  result  of 
infection  is  discussed  at  some  length.  By  referring  to  this 
chapter,  it  will  be  observed  that  in  nearly  all  cases  of  orchi- 
tis and  epididymitis  the  disease  is  bilateral,  which  would  in- 
dicate very  strongly  that  it  is  due  to  some  systemic  infection 


Traumatic  Orchitis 


I  S3 


F[G.  59a— GunshotWounds  of  Testicles.     Bull. 

.v.  Gunshot  embedded  in  right  epididymis  ;  ^j,  gunshot  embedded  in  left 
testis  ;  //,  globus  major  of  epididymis  ;  T,  globus  minor,  do  ;  A.  rough- 
ened surface  from  inflammatory  thickenings.  The  orchitic  peritoneum  is 
generally  roughened  on  account  of  traumatic  peritonitis. 


1 84  Diseases  of  the  Genital  Organs 

arising  from  the  presence  in  the  blood  stream  of  pathogenic 
organisms  having  a  distinct  affinity  for  the  genital  organs. 
The  lesions  figured  and  described  are  distinctly  those  of  in- 
fection and  not  of  traumatism. 

Before  diagnosing  traumatic  orchitis  in  any  animal,  one 
should  give  ample  consideration  to  the  facts  as  stated  and 
should  in  addition  know  that  there  has  been  a  severe  trau- 
matism of  the  gland  or  glands. 

It  is  quite  possible  that  mechanical  injury  plays  a  very 
important  part  in  bringing  about  a  crisis  when  infection  is 
already  present  within  the  gland.  That  is  the  general  rule 
in  the  etiology  of  disease  in  any  organ  of  the  body,  and  ap- 
parently applies  with  special  force  to  the  diseases  of  the 
genital  organs.  Thus  Hendricks,  to  whom  reference  has 
been  made  above,  states  that  excessive  coitus  serves  as  a 
fertile  cause  of  this  disease.  Excessive  coitus,  however, 
cannot  be  regarded  as  traumatism.  It  must,  instead,  be 
looked  upon  as  an  overworking  of  a  gland  by  which  it  be- 
comes weakened  and  its  tissues  lose  their  power  of  resis- 
tance toward  disease-producing  microorganisms  which  are 
already  present  in  the  part. 

When  the  veterinarian  feels  justified  in  diagnosing  trau- 
matic orchitis,  the  prognosis  will  of  course  depend  upon  the 
nature  of  the  trauma.  The  treatment  also  needs  to  be  ad- 
justed to  the  general  principles  of  surgery  in  fiartrio'ny  with 
the  character  of  the  injury.  Speaking  generally,  care  should 
be  taken  to  obviate,  as  far  as  possible,  the  invasion  of  thfe 
gland  by  bacteria  because  of  injury  to  the  skin  and  other 
coverings.  It  is  likewise  important  that  the  interferences 
with  the  circulation  in  the  testicles  should  be  anticipated 
and  prevented,  if  possible,  by  the  careful  application  of  a 
suspensorium.  In  ruminants,  in  addition  to  the  suspenso- 
rium,  the  testicles  can  be  inclosed  in  a  bandage  of  adhesive 
tape  in  such  a  manner  as  to  exert  uniform  and  gentle  pres- 
sure upon  the  glands  and  thereby  maintain  the  efficiency  of 
the  circulation.  Sexual  excitement  should  be  strictly  avoided. 
The  bowels  should  be  kept  freely  open  as  in  any  case  of  dis- 
ease where  fever  is  likely  to  occur,  and  the  diet  should  be 
properly  adjusted. 


Tubal  Pregnancy  185 

I.    Tubal  Pregnancy 

Tubal  pregnancy,  comparatively  common  in  woman,  has 
not,  so  far  as  I  know,  been  recorded  in  any  domestic  ani- 
mal, but  it  is  quite  possible  and  may  be  encountered  by  the 
veterinarian  when  he  is  examining  the  genitalia.  The  fact 
that  extra-uterine  pregnancy  is  now  and  then  encountered 
in  the  abattoir  renders  it  highly  probable  that  tubal  preg- 
nancy does  at  times  occur  in  animals.  The  veterinarian 
does  not  have  the  means  for  diagnosis  afforded  in  woman 
by  the  regular  occurrence  of  hemorrhage  from  the  uterus, 
since  the  cervix  is  too  securely  sealed,  but  he  has  a  distinct 
advantage  over  the  human  obstetrist  in  the  facility  with 
which  palpation  per  rectum  may  be  applied.  The  condition 
would  necessarily  give  rise  to  a  cystic  enlargement  in  the 
oviduct,  associated  with  a  typical  corpus  luteum  of  preg- 
nancy in  the  corresponding  ovary,  a  typical  uterine  seal,  en- 
largement of  the  ovarian  artery,  and  an  absence  of  estrum. 
If  tubal  pregnancy  is  diagnosed,  the  peril  from  rupture  of 
the  oviduct  should  be  promptly  removed  by  performing 
laparotomy  in  the  upper  flank  on  the  involved  side,  followed 
by  the  amputation  of  the  tube  and  ovary.  If  the  other  side 
of  the  reproductive  tract  is  sound,  the  fertility  of  the  ani- 
mal is  not  disturbed. 

After  the  oviduct  has  ruptured  and  the  ovum  has  escaped 
into  the  peritoneal  cavity,  if  the  accident  is  discovered 
early  and  there  are  evidences  of  serious  internal  hemor- 
rhage, the  animal,  if  of  a  species  used  for  food  and  other- 
wise fit,  should  be  slaughtered  imm.ediately.  Should  the 
veterinarian  by  chance  diagnose  an  old-standing  extra- 
uterine pregnancy,  with  the  fetus  securely  anchored  and 
enveloped,  the  fact  is  to  be  wholly  disregarded,  except  that 
the  animal  is  probably  permanently  sterile  on  the  side  where 
the  pregnancy  originated. 

J.    Vaginal  Hernia 

Vaginal  hernia,  or  hernia  through  the  vulvo-vaginal  mus- 
cular wall,  is  not  infrequent  in  cows.  In  the  cases  I  have 
observed  there  was  a  rent  in  the  lateral  wall  of  the  vagina 


1 86  Diseases  of  the  Geyiital  Organs 

at  the  hymeneal  ring.  The  symptoms  consist  of  the  ap- 
pearance between  the  vulvar  lips,  or  projecting  beyond 
them,  when  the  patient  is  lying  down,  of  a  fluctuant,  globu- 
lar mass,  covered  by  the  vaginal  mucosa.  When  the  cow  is 
caused  to  stand,  the  hernial  mass  usually  disappears  spon- 
taneously, or,  if  it  does  not,  readily  disappears  under  gentle 
manual  compression.  Then  the  veterinarian  can  readily 
recognize  a  well  defined  hernial  ring  of  variable  size,  ad- 
mitting the  insertion  of  two  fingers  or  the  entire  hand.  The 
veterinarian  should  constantly  be  on  the  alert  not  to  confuse 
vaginal  hernia  with  prolapse.  Prolapse  of  the  vagina  is  not 
so  frequent  as  vaginal  hernia.  I  have  seen  colleagues  err 
in  diagnosis.  The  size  of  the  hernial  mass  increases  as 
pregnancy  advances.  The  mucosa  of  the  hernial  sac  be- 
comes somewhat  befouled  and  inflamed  by  constant  ex- 
posure to  filth  when  the  animal  is  lying  down,  but  in  the 
cases  I  have  observed  there  has  been  no  recognizable  incon- 
venience. The  hernia  constitutes  a  repulsive  defect  not 
wholly  devoid  of  peril  to  the  animal.  I  have  observed  five 
cases  of  this  hernia,  all  in  pedigreed  cows.  With  one  ex- 
ception, all  had  been  purchased  as  presumably  sound  by 
the  parties  owning  them  at  the  time  of  examination.  The 
one  owned  by  her  breeder  had  developed  a  fibroma  at  the 
hymeneal  ring,  which  protruded  beyond  the  vulva.  The 
veterinarian  removed  the  tumor  by  ecrasement.  Evidently 
the  chain  of  the  ecraseur  included  a  portion  of  the  muscu- 
lar wall  of  the  vagina,  thus  causing  an  opening  into  the 
pelvic  connective  tissue,  behind  the  peritoneum.  The  intra- 
abdominal pressure  pushed  portions  of  the  small  intestine 
against  the  peritoneum  and  forced  it  out  through  the  vent 
in  the  vulvo-vaginal  wall,  to  constitute  a  hernia.  It  is  not 
impossible  that  the  other  cases  I  observed  were  caused  in 
the  same  way,  since  the  vestiges  of  the  hymen  are  fre- 
quently the  seat  of  fibroid  tumors  and  the  veterinarian, 
when  called  to  remove  them,  resorts  to  the  ecraseur.  with- 
out thinking  of  the  consequences.  The  tumors  will  be  dis- 
cussed later.     As  I  now  recall,  the  hernia  has  been  on  the 


Vaginal  Hernia 


187 


right  side  in  most  of  my  cases.  The  initial  injury  must  be 
as  frequent  on  the  left  as  on  the  right  side,  but  the  intra- 
pelvic  content  of  the  small  intestine  is  greater  on  the  right 
and  would  tend  rather  to  develop  a  hernia  in  a  weakened 
area. 


Fig.  60 — Sutures  For  Vaginal  Hernia. 
The  insert  below  at  the  left  shows  details  of  suture. 


Although  I  have  not  had  an  opportunity  to  operate  upon 
a  case,  and  thus  can  not  speak  from  experience,  the  condi- 
tion should  be  amenable  to  surgical  interference.  The  oper- 
ation could  be  done  best  upon  the  non-pregnant  animal,  al- 
lowed only  a  small  volume  of  food  in  order  to  lower  the  in- 


1 88  Diseases  of  the  Gefiital  Organs 

tra-pelvic  pressure  upon  the  operative  area.  It  would  be 
practicable  to  operate  upon  most  cows  under  local  anaes- 
thesia in  the  standing-  position.  After  carefully  cleansing 
the  vulva  and  vagina,  an  incision  may  be  made  through  the 
vulvar  mucosa  of  the  hernial  sac,  down  to  the  pelvic  fascia. 
An  index  finger  can  be  inserted  through  the  incision  and, 
palpating  the  hernial  ring,  act  as  a  guide  in  suturing.  A 
half-curve  needle  armed  with  strong  silk  should  then  be  in- 
serted at  a  point  on  a  level  with  the  superior  border  of  the 
hernial  ring  and  about  one-half  inch  posterior  to  the  mar- 
gin. The  needle  is  to  be  passed  through  the  vulvar  mucosa 
and  the  muscular  wall ;  carried  forward,  carefully  guarded, 
across  the  hernial  opening  on  the  ovarian  side  of  the  ante- 
rior margin  of  the  hernial  ring ;  and  finally  brought  out  into 
the  vagina,  through  the  muscular  and  mucous  coats.  Then 
the  needle  is  to  be  reversed,  carried  downward  about  one- 
fourth  inch,  inserted,  and  a  suture  laid  parallel  to  the  first, 
emerging  about  one-fourth  inch  below  the  point  of  starting. 
The  free  ends  of  the  suture  are  then  brought  together  and 
tied  tightly,  with  a  view  to  inducing  pressure  necrosis  in 
the  tissues  incarcerated  in  the  loop.  The  sutures  should  be 
repeated  every  quarter  of  an  inch,  from  the  upper  to  the 
lower  margin  of  the  hernial  ring.  The  ring  will  then  be 
obliterated,  and  adhesion  occur  between  the  incarcerated 
tissues.  The  portions  of  tissue  lying  between  the  incar- 
cerated areas  in  the  sutures  serve  to  maintain  function  in 
the  hernial  sac,  preventing  it  from  sloughing  away,  and  the 
possibility  of  prolapse  of  the  intestine  through  the  slough. 
When  circumstances  render  it  desirable  to  apply  pallia- 
tive measures  to  ventral  hernia  pending  parturition,  the 
object  is  readily  accomplished  by  means  of  vulvar  sutures, 
as  shown  in  Fig.  60.  In  the  illustration,  tape  has  been  used 
for  sutures.  A  loop  has  been  tied  near  the  middle  of  the 
suture,  after  which  the  needle  is  inserted  about  one  inch 
lateral  to  the  vulvar  opening,  somewhat  below  the  superior 
commissure,  carried  downward  nearly  to  the  inferior  com- 
missure, and  brought  out.     The  ends  are  then  tied  together 


Torsion  of  the  Uterus  189 

firmly,  leaving  sufficient  free  tape  to  reach  across  the  vulva 
to  the  suture  of  the  other  side,  to  which  it  is  tied  by  a  bow- 
knot.  The  sutures  can  be  untied  at  will  while  the  vulva, 
vagina,  and  sutures  are  cleansed. 

The  suture  is  better  when  made  of  heavy  silver  wire.  It 
irritates  the  tissues  less  than  the  tape  and  is  cleaner.  It 
has  the  great  advantage,  also,  that  the  ends  of  the  wires 
crossing  over  the  vulva  may  be  fastened  by  merely  bending 
them  over  the  suture,  so  that,  if  parturition  commences  in 
the  absence  of  an  attendant  the  force  will  cause  the  wire 
hook  to  unbend  and  the  vulvar  lips  to  part.  Similar  pro- 
vision may  be  made  with  tape  by  using  for  the  cross  liga- 
tures, tape  or  cord  of  low  tensile  strength  which,  in  case  of 
labor  pains,  will  break.  Otherwise,  there  is  danger  of  in- 
terference with  parturition  and  special  danger  of  lacera- 
tions of  the  vulva  owing  to  pressure  upon  the  sutures. 

K.    Torsion  of  the  Uterus 

Torsion  of  the  uterus  is  generally  considered  only  as  a 
cause  of  dystocia  at  or  near  the  full  term  of  pregnancy.  It 
has  been  quite  fully  discussed  in  the  companion  volume 
upon  Veterinary  Obstetrics.  It  is  well  to  add  that  uterine 
torsion  occurs  quite  independently  from  the  near  approach 
of  parturition.  In  the  cow  it  may  be  encountered  when 
palpating  the  genitalia  at  least  as  early  as  the  145th  day  of 
pregnancy.  It  may  cause  colicky  pains,  or  merely  dullness, 
or  for  a  time  no  symptoms  at  all.  Therefore  the  practi- 
tioner may  be  called  to  examine  the  cow  because  she  has 
shown  signs  of  disease,  or  he  may  detect  the  torsion  in  the 
course  of  an  examination  of  the  genitalia  as  a  part  of  the 
control  of  sterility  and  abortion. 

When  a  veterinarian  is  called  to  attend  a  cow  showing  oc- 
cult evidences  of  disease,  he  should  always  have  in  mind  the 
important  role  played  by  the  genital  organs  and  make  a 
careful  examination.  When  the  displacement  occurs  early, 
as  in  the  cow  already  cited,  there  may  be  no  manifestations 
of  disease  or  discomfort.    The  torsion  in  the  small  and  not 


IQO 


Diseases  of  the  Genital  Organs 


fully  distended  uterus  may  occur  so  far  forward  that  the 
usual  spiral  folding  of  the  vaginal  walls  may  be  wanting. 
Therefore  it  may  be  stated  as  a  law  that  rectal  palpation  is 
essential  to  a  proper  determination  of  the  state  of  the  uterus. 
When  the  uterus  which  has  undergone  torsion  is  palpated 
per  rectum,  it  offers  certain  definite  characteristics : 

1.  The  posterior  portion  of  the  uterus  can  not  be  clearly 
palpated,  because  one  of  the  broad  ligaments  is  tightly 
stretched  across  the  organ,  completely  covering  it.  Far  for- 
ward, in  front  of  the  broad  ligament,  the  examiner  may  di- 
rectly palpate  the  gravid  uterus  and  the  contained  fetus.  If 
the  uterus  has  revolved  to  the  left— that  is,  if  in  the  begin- 
ning of  the  displacement  the  dorsal  wall  of  the  uterus  has 
moved  to  the  left,  while  the  ventral  or  lower  wall  moves  to 
the  right — the  right  broad  ligament  passes  over  the  vagina 
and  uterus  to  the  left,  while  the  left  broad  ligament  passes 
beneath  the  vagina  and  uterus  to  the  right.  Both  ligaments 
are  tensely  stretched. 

2.  The  chief  uterine  artery  inevitably  moves  with  the 
broad  ligament,  and  is  readily  felt.  In  left  torsion,  the 
right  uterine  artery,  tightly  stretched,  passes  over  the 
uterus  to  the  left  side,  while  the  right  artery  is  forced 
down  along  the  pelvic  floor  and  passes  beneath  the  uterus 
and  vagina,  to  the  right.  The  torsion  constitutes  a  for- 
midable obstacle  to  the  circulation  in  the  entire  genital 
tract  anterior  to  the  turn,  causing  the  arteries  to  become 
distended  and  the  pulsation  in  them  to  be  unusually  full 
and  bounding.  These  findings  serve  to  identify  the  char- 
acter of  the  displacement.  Moderate  uterine  torsion,  with- 
out transverse  rupture  of  the  uterus  or  vagina,  recognized 
in  time,  warrants  a  highly  favorable  prognosis.  The  chief 
indication  is  the  rolling  process  already  fully  described  in 
the  companion  volume,  Vetennanj  Oh^fctricii. 

L.    Pelvic  Tumors  and  C'alluses 

Occasionally,  when  examining  the  genital  organs  ol 
mares  or  cows,  one  finds  tumors  in  the  pelvis  botwiHMi  the 


Pelvic  TuDiors  and  Calluses  191 

pelvic  walls  and  the  vagina,  which  may  interfere  with  fer- 
tility— not  so  frequently  with  fertilization  as  with  parturi- 
tion. These  should  always  be  observed  carefully  and  pre- 
cautions taken  against  impending  difficulty.  If  the  tumors 
are  irremovable,  the  animal  should  not  be  bred ;  if  she  is 
pregnant,  artificial  abortion  may  be  performed,  in  the  early 
stages,  or,  if  the  fetus  is  of  value,  pregnancy  may  be  per- 
mitted to  continue  to  full  term  and  the  young  removed  by 
hysterotomy. 

A  commoner  interference  with  reproduction  consists  of 
calluses  resulting  from  fractures  or  other  injuries  to  the 
bony  girdle  of  the  pelvis.  Pelvic  fractures  with  large  cal- 
luses are  especially  common  in  nymphomaniac  cows,  and 
sometimes  unfit  them  for  breeding.  Even  if  the  nympho- 
mania can  be  overcome,  where  such  injuries  are  encoun- 
tered during  examination,  the  veterinarian  should  judge 
carefully  of  their  importance  and  act  accordingly.  If  they 
are  of  such  a  character  as  to  prevent  parturition,  the  ani- 
mal should  not  be  treated  for  the  disease  of  the  genital  or- 
gans, but  be  sent  to  slaughter.  Exceptions  might  be  made 
in  highly  valuable  cows,  which,  if  the  nymphomania  or  other 
disease  is  curable,  might  be  bred  and  delivered  at  full  term 
by  hysterotomy. 


Chapter   VI 

SYSTEMIC  DISEASES  AND  DERANGEMENTS 
INTERFERING  WITH  REPRODUCTION 

Reproduction  is  the  culminating  function  of  animal  life. 
The  fundamental  demand  of  the  individual  is  the  mainte- 
nance of  life,  and  it  is  only  when  this  has  been  reasonably 
assured  that  any  additional  power  may  be  directed  to  the 
reproduction  of  the  species.  During  the  most  active  stages 
of  growth,  most  animals  do  not  breed.  When  old  age  comes, 
and  the  maintenance  of  nutrition  is  difficult,  reproduction 
becomes  uncertain  or  ceases.  Throughout  adult  life,  any 
element  which  interferes  seriously  with  nutrition  promptly 
imperils  reproduction. 

During  the  course  of  acute  infectious  diseases,  with  rare 
exceptions,  male  animals  do  not  elaborate  spermatozoa  and 
females  do  not  ovulate.  At  the  same  time,  sexual  desire 
ceases.  In  the  pregnant  female  such  diseases  imperil  the 
life  of  the  fetus.  So  it  is  frequently  said  of  cows  that  foot- 
and-mouth  disease,  pleuro-pneumonia,  and  similar  fevers 
tend  to  cause  abortion.  This  does  not  imply  that  the  in- 
fectious fever  directly  causes  the  abortion,  but  rather  that 
the  infection  present  within  the  pregnant  uterus,  capable 
under  favorable  conditions  of  causing  the  death  and  expul- 
sion of  the  fetus,  is  rendered  virulent  by  the  general  de- 
pression of  the  system  due  to  infectious  fever.  Such  chronic, 
debilitating  affections  as  the  bone  diseases — osteoporosis, 
rickets,  spavin,  ringbone,  and  others — commonly  lead  to 
sterility  through  their  devigorating  influence. 
A.    Overwork 

Animals  subjected  to  severe  work  are  strongly  inclined 
to  be  sterile  for  the  time.  In  stallions  which  are  being 
trained  for  the  turf,  there  is  usually  temporary  sterility, 
without  any  evidence  of  disease  or  degeneration  of  the 
glands.  The  resources  of  the  animal  are  wholly  consumed 
in  the  physical  work  which  is  demanded,  and  there  remains 
no  reserve  force  to  provide  reproductive  energy  during  this 
period. 


Starvation  193 

B.    Starvation 

Starvation  exerts  an  influence  parallel  to  that  of  acute 
disease.  In  the  young  animal  the  development  of  the  sex 
functions  is  advanced  or  delayed  according  to  the  state  of 
nutrition.  In  highly  fed,  vigorous  heifer  calves,  ovulation 
and  estrum  may  occur  at  six  months,  or  even  earlier.  In 
countries  where  cattle  are  reared  in  a  semi-v^ild  state,  con- 
stantly running  at  large  where  herbage  is  scanty,  they 
rarely  ovulate  until  nearly  two  years  old,  so  that,  although 
the  bulls  run  in  the  herd,  the  heifers  do  not  conceive  until 
well  grown.  The  nutritive  supply  beyond  the  necessities  of 
the  individual  do  not  suffice  for  reproduction.  In  cattle 
more  highly  domesticated,  if  they  are  underfed  or  otherwise 
badly  handled,  ovulation  or  estrum  frequently  fails.  I  have 
observed  two-year-old  heifers,  badly  kept,  though  not  ex- 
tremely poor,  which  failed  to  come  in  estrum  because  of 
poverty,  but  bred  promptly  when  the  food  supply  was  in- 
creased. Semi-wild  cattle  generally  conceive  in  early  sum- 
mer, at  the  time  when  grazing  is  at  its  best  and  the  animal 
has  recovered  its  vigor  after  the  privations  of  winter.  The 
same  rule  applies  to  cattle  stabled  in  winter  and  grazed 
during  the  summer.  Animals  which  do  not  come  in  estrum 
in  the  stable  or,  doing  so,  do  not  conceive,  frequently  breed 
when  increased  vigor  has  been  gained  after  grazing  on 
good  pasture. 

A  high  state  of  nutrition  does  not  necessarily  accompany 
an  abundance  of  food.  Any  food  may  be  so  damaged  that 
its  nutritive  value  may  be  lowered  or  destroyed,  or,  con- 
taminated by  various  bacteria  or  fungi,  it  may  become  toxic. 
Mere  quantity  of  food,  and  even  of  technical  nutritive  ele- 
ments in  the  food,  does  not  mean  good  nutrition.  I  observed 
a  stable  of  cows  and  heifers  which  were  getting  an  abun- 
dance of  hay  and  grain  of  excellent  quality,  but  all  were  un- 
thrifty and  emaciated.  The  non-pregnant  animals  did  not 
come  in  estrum.  One  cow  could  scarcely  get  up  when  down. 
They  were  in  charge  of  a  lazy  attendant,  who  gave  them 
plenty  of  food  with  fair  regularity,  but  did  not  keep  them 

13 


[94 


Diseases  of  the  Genital  Organs 


clean.  So  far  as  I  could  learn,  the  foundation  for  the  de- 
bility was  his  failure  to  carry  a  reasonable  supply  of  water 
a  few  paces.  A  change  of  caretakers  promptly  relieved  the 
condition,  and  within  a  month  cows  began  to  show  estrum 
and  conceived  promptly. 

C.    Obesity 

Abundant  food  and  a  high  state  of  nutrition  must  not  be 
confused  with  obesity.  Obesity  is  not  vigor,  but  may  be  the 
reverse.  Vigor  and  an  abundance  of  fat  may  coexist  and 
are  not  incompatible.  While  obesity  may  sometimes  cause 
sterility,  it  is  far  more  frequently  true  that  sterility  causes 
obesity.  That  is,  if  a  cow  or  heifer  is  sterile,  she  does  no 
work,  has  abundant  food,  and  is  perhaps  closely  confined  in 
the  stanchion.  No  special  functional  activities  are  present, 
such  as  the  secretion  of  butter  fat  or  other  product,  which 
would  consume  the  extra  nutrient  materials  taken  in  the 
food.  Consequently  the  animal  takes  on  an  abnormal  quan- 
tity of  fat. 

In  many  cases  the  obesity  of  sterility  apparently  has  a 
more  interesting  significance  than  the  mere  conversion  of 
redundant  nutritive  material  into  fat.  This  is  preeminently 
notable  in  cattle.  The  sterile  heifer  or  cow  frequently  has 
irregular,  lumpy  deposits  of  fat,  especially  great,  irregular 
lumps  about  the  external  iliac  and  ischiatic  tuberosities. 
The  hair  becomes  rough  and  lustreless.  The  form  of  the 
body  becomes  coarse  and  uncouth.  If  the  genital  organs  are 
examined,  no  great  departure  from  the  normal  is  found. 
Perhaps  the  ovaries  are  rather  small  and  the  genital  system 
is  wanting  in  tone.  The  animal  may  be  dull  and  estrum  ca- 
pricious. 

The  cause  appears  to  be  a  disturbance  of  endocrine  secre- 
tions, probably  a  faulty  secretion  of  the  ovaries  themselves, 
which  so  modifies  the  nutritive  system  as  a  whole  that  fat 
deposits  are  made  in  a  manner  quite  in  conflict  with  the  gen- 
eral physiologic  laws  of  nutrition.  Physiologic  heifers  or 
cows  may  carry  quite  as  much  fat  as  the  obese,  sterile  ani- 
mal, but  it  is  more  evenly  distributed,  the  coat  retains  its 


Obesity  I95 

lustre,  the  animal  is  bright  and  alert,  and  is  fertile.  I  think 
that  obesity  as  a  cause  of  sterility  in  cattle  has  been  over- 
emphasized, though  I  admit  the  importance  of  controlling  it 
by  properly  adjusted  rations,  combined  with  exercise. 

A  distinction  needs  to  be  made  between  obesity  and  over- 
feeding. While  obesity  is  sometimes  due  to  overfeeding, 
especially  when  combined  with  idleness,  overfeeding  may 
cause  a  serious  impediment  to  sex  functions  without  pro- 
ducing marked  obesity.  I  have  seen  bulls  which  were  fed 
an  excessively  large  amount  of  very  poor,  hard,  woody  hay. 
The  manager,  wishing  to  prevent  them  from  getting  over- 
fat,  was  feeding  coarse  hay  in  the  dairy.  After  the  cows 
had  picked  out  the  best  portions,  the  refuse,  consisting  of 
weeds  and  very  coarse  stems  of  hay,  was  fed  to  the  bulls, 
with  a  view  to  affording  an  abundant  bulk  of  food  having  a 
very  low  nutritive  value.  The  abdomen  of  each  bull, 
though  they  were  in  moderate  flesh,  became  excessively 
large.  Some  individuals  lost  almost  completely  their  sexual 
desire.  While  ruminants  are  adapted  to  using  large  vol- 
umes of  dry  fodder,  the  hygienic  maximum  is  readily  ex- 
ceeded, especially  in  herd  bulls  closely  confined. 

Even  when  such  overfeeding  with  a  poor  quality  of  fod- 
der does  not  seriously  depress  the  sexual  functions,  it  not 
infrequently  interferes  with  the  physical  ability  to  copulate. 
The  immense  weight  of  the  load  in  the  rumen,  with  its  pres- 
sure against  the  diaphragm  and  lungs,  renders  the  bull 
slow,  awkward,  and  short  of  breath.  I  have  seen  such  bulls 
fail  utterly  to  copulate.  The  great  intra-abdominal  weight 
and  tension  made  mounting  very  difficult,  and  the  enormous 
belly  served  to  prevent  coitus,  since  the  pressure  of  the  tense 
abdomen  upon  the  rump  of  the  cow  forced  the  abdominal 
viscera  against  the  diaphragm  so  that  the  bull  was  quickly 
out  of  breath  and  exhausted. 

A  breeding  male  should  be  fed  like  any  other  animal  which 
one  desires  to  keep  in  vigorous  condition.  The  bulk  of  the 
food  and  the  amount  of  nutriment  contained  should  be  ad- 
justed to  the  needs  of  the  individual,  having  due  respect  for 
size,  age,  and  the  exercise  or  work  provided. 


196  Diseases  of  the  Genital  Organs 

The  direct  influence  of  certain  foods  upon  fertility  has 
frequently  been  asserted  but  is  difficult  to  trace.  It  is  a 
favorite  habit  of  the  breeder  and  dairyman,  when  his  herd 
shows  a  low  rate  of  reproduction,  to  attribute  it  directly  to 
food — ensilage,  alfalfa,  clover,  cottonseed  meal,  and  well- 
nigh  every  food.  Indirectly,  foods  modify  reproduction 
greatly  because  the  general  vigor  depends  more  upon  the 
quantity  and  quality  of  food  than  upon  any  other  one  ele- 
ment. 

D.    Idleness  and  Overfeeding 

Impotence  of  the  male  is  sometimes  expressed  chiefly  by 
an  absence  of  sexual  desire  in  the  presence  of  females  prop- 
erly in  estrum,  without  any  visible  changes  of  the  reproduc- 
tive organs.  Sometimes  he  may  pay  attention  to  the  female, 
with  more  or  less  complete  erection  of  the  penis,  then  desist 
in  his  attentions,  and  turn  away.  When  the  next  female  is 
presented,  he  may  show  normal  sexual  vigor. 

In  some  cases,  there  is  said  to  be  an  individual  psychic  in- 
fluence which  prevents  the  male  from  copulating  with  a  cer- 
tain female.  This  is  alleged  to  be  especially  true  of  individ- 
ual stallions,  to  which  certain  mares  seem  to  be  repulsive,  so 
that  they  refuse  to  copulate  with  them.  The  presence  of 
young  at  the  side  of  the  dam  is  sometimes  alleged  to  repress 
the  sexual  appetite  of  the  male.  This  is  usually  seen,  however, 
only  in  those  males  depressed  in  their  vitality.  It  is  almost, 
if  not  always,  erroneous  to  attribute  absence  of  sexual  de- 
sire to  the  caprice  or  idiosyncracies  of  the  male,  by  which 
a  female  of  a  certain  type  or  color  becomes  repulsive  to 
him  and  fails  to  arouse  his  sexual  appetite ;  the  real  cause 
lies  in  bad  management  or  in  disease. 

The  tendency  to  loss  of  vigor  on  this  account  is  usually 
not  noticeable  in  the  young,  but,  as  soon  as  the  animal  has 
become  mature  and  grown  quite  fat,  the  disposition  becomes 
marked.  This  form  of  impotence  is  seen  almost  exclusively 
in  those  animals  which  are  closely  confined,  highly  fed.  and 
not  properly  exercised.  It  is  commonest  in  draft  stallions, 
but  is  observed  in  bulls,  especially  of  the  beef  breeds,  and  in 
male  breeding  animals  of  all  species.    It  tends  to  disappear 


Idleness  arid  Overfeeding  197 

promptly  upon  a  correction  of  the  method  of  keeping,  pro- 
viding that  it  be  appHed  sufficiently  early. 

The  difficulty  should  be  prevented  by  not  forcing  the 
young  male  designed  for  breeding  purposes  too  rapidly  in 
his  development.  He  should  be  allowed  only  a  moderate 
diet,  with  plenty  of  exercise  and  freedom,  or  be  given  actual 
work. 

Upon  the  appearance  of  these  defects  in  the  mature  ani- 
mal, much  can  be  done,  if  handled  opportunely,  by  restrict- 
ing the  diet  and  causing  an  abundance  of  exercise.  A 
healthy  young  draft  stallion  belonging  to  one  of  my  clients 
refused  almost  wholly  to  serve  mares.  He  was  being  highly 
fed  and  was  getting  a  very  limited  amount  of  exercise,  at  a 
slow  walk.  Being  appealed  to  for  advice,  I  reduced  his 
food  ration  one-half  and  prescribed  eight  miles  exercise 
daily,  at  a  brisk  walk.  Within  a  few  days,  his  sexual  de- 
sire had  fully  returned.  He  finished  his  season's  work  in 
good  form,  and  was  effective  as  a  sire.  The  same  general 
principles  apply  to  other  breeding  males.  In  countries 
where  cattle  are  habitually  worked,  the  bulls  are  kept  in 
breeding  condition  by  moderate  draft  service.  It  would  be 
well  to  imitate  this  plan  in  America,  where  bulls  and  stal- 
lions are  not  habitually  used  for  work,  but  could  readily 
render  valuable  service  while  being  greatly  benefited  by 
the  vigorous  exercise  secured.  Under  general  conditions, 
it  is  perhaps  the  best  possible  and  most  economic  manner 
by  which  sufficient  exercise  for  these  animals  can  be  as- 
sured. Incidentally,  it  should  be  noted  that  such  exercise 
or  work  tends  very  strongly  to  prevent  that  viciousness  in 
bulls  and  stallions  which  renders  them  dangerous  to  their 
keepers. 

Zschokke  emphasizes  the  value  of  the  proper  selection  of 
food  for  the  purpose  of  arousing  sexual  desire,  and  insists 
especially  that  the  hay  should  be  aromatic,  as  should  also 
the  oats.  Not  only  should  they  be  well  cured  and  sweet- 
smelling,  but  he  believes  that  the  admixture  of  certain 
stimulants,  such  as  calamus,  pepper,  powdered  mustard, 
and   even   powdered   cantharides,   are   advantageous.      He 


198  Diseases  of  the  Genital  Organs 

recommends  that  these  remedies  be  fed  with  cut  hay  and 
that  they  be  allowed  for  two  or  three  days  in  succession  and 
then  omitted  for  the  same  length  of  time,  when  they  may 
be  given  again.  I  doubt  very  greatly  the  value  of  aphrodisi- 
acs, or  sexual  stimulants,  in  breeding  animals.  Sexual  in- 
stinct is  normal  and  so  universal  in  animals  of  breeding 
age  and  in  proper  health  that  I  fail  to  see  the  value  of  ex- 
citing sexual  desire  artificially.  If  sexual  instinct  is  ab- 
sent, it  is  because  of  some  disease  of,  or  depression  in  the 
general  vigor  of  the  animal,  which  can  not  readily  be  re- 
moved by  aphrodisiacs.  It  has  not  been  shown  that  the 
arousal  of  sexual  appetite  by  means  of  these  drugs  insures 
or  even  favors  fertility.  A  constant  and  wide  distinction 
must  be  drawn  between  copulation  and  fecundation.  The 
fundamental  function  of  the  male  is  the  elaboration  of  virile 
spermatozoa,  or  male  cells,  and  of  the  female  to  produce 
healthy  ova.  Copulation  serves  merely  to  transfer  these 
fecunding  cells  from  the  testes  of  the  male  to  the  vagina  of 
the  female.  Copulation  is  in  vain  without  vigorous  sper- 
matozoa and  healthy  ova,  and  no  data  exist  to  show  or  sug- 
gest that  any  drug  may  directly  cause  or  favor  their  devel- 
opment. 

Certainly  it  must  be  admitted  that  tonics,  alteratives,  or 
other  drugs  capable  of  influencing  favorably  the  restoration 
of  a  diseased  animal  to  a  state  of  health  must  also  improve 
its  reproductive  powers,  by  restoring  the  equilibrium  of  the 
body  and  enabling  it  to  perform  better  all  its  normal  func- 
tions, among  which  is  reproduction  .  The  highest  state  of 
the  general  vigor  of  the  body  is,  consequently,  the  most 
favorable  condition  for  the  production  of  virile  spermatozoa 
and  ova,  which  constitute  the  first  essential  in  fertility  . 

Sometimes  there  is  an  apparent  absence  of  sexual  desire 
in  young  males  when  first  brought  in  contact  with  estrual 
females  for  purposes  of  coitus.  If  such  animals  are  turned 
loose  with  the  females,  the  difficulty  is  generally  overcome 
very  promptly. 

The  preparation  of  breeding  animals  for  the  show  is  al- 
ways dangerous  for  their  sexual  vitality.     In  order  to  get 


Idleness  and  Overfeeding  199 

them  in  high  condition,  they  are  frequently  closely  confined 
and  fed  in  such  a  manner  as  to  produce  the  greatest  amount 
of  fat,  in  the  hope  that  they  may  make  a  better  showing  and 
more  certainly  win  a  prize.  It  is  an  unfortunate  fact  that 
many  of  the  most  richly  bred  animals,  designed  for  breeding 
purposes,  which  capture  the  most  coveted  prizes  at  the 
livestock  fairs,  have  their  breeding  powers  either  tempo- 
rarily or  permanently  destroyed  in  the  process  of  feeding 
them  for  the  show.  There  is  no  effective  method  for  over- 
coming this  except  by  the  exercise  of  greater  intelligence 
on  the  part  of  the  owners  of  show  animals,  which  may  be 
furthered  by  judges  in  livestock  exhibitions  paying  less  at- 
tention to  the  amount  of  fat  and  more  to  the  form  and  gen- 
eral vigor  of  the  animal,  in  the  allotment  of  premiums.  In 
order  to  show  breeding  animals  with  safety,  it  is  absolutely 
essential  that  abundant  exercise  should  accompany  the  pre- 
paring process,  if  the  sexual  vigor  of  the  animal  is  to  be 
safely  preserved. 

The  result  is  not  the  same  with  all  individuals.  There 
are  some  which  can  withstand  almost  unlimited  abuse  in 
this  direction  and  continue  to  breed  regularly,  while  others' 
are  very  susceptible  and  soon  become  temporarily  or  per- 
manently sterile.  Once  this  sterility  is  established,  the  only 
thing  that  can  be  done  is  to  correct  errors  in  care  by  moder- 
ating the  diet  and  enforcing  vigorous  exercise,  which  will 
sometimes,  though  not  always,  restore  the  sexual  powers. 

In  a  general  way,  the  food  of  a  breeding  male  needs  to 
be  rich  in  protein,  as  compared  with  the  amount  of  hydro- 
carbons and  carbohydrates.  The  commonest  foods,  when 
well  grown  and  cured,  are  the  best  for  the  breeding  animal, 
such  as  bright,  aromatic  hay  and  clean,  well  developed  oats, 
along  with  grass,  to  which  may  be  added,  in  the  winter, 
roots  and  tubers.  Rarely,  if  ever,  is  it  necessary  or  even 
advisable  or  permissible  to  add  to  the  food  any  sexual  stimu- 
lant like  pepper  or  mustard. 

It  should  be  observed  that  interferences  with  reproduc- 
tion by  confinement,  overwork,  overfeeding,  starvation,  and 
other  imprudent  details  of  handling  exert  their  pernicious 


200  Diseases  of  the  Genital  Orgaiis 

influence  through  two  separate  channels.  In  the  first  place, 
overwork  or  starvation,  by  lowering  nutrition  of  mature 
genital  cells,  directly  inhibits  reproduction.  The  functions 
of  the  sex  glands  are  such  that  neither  the  physical  over- 
exertion of  the  animal  nor  starvation  can  extend  its  influ- 
ence bej'ond  the  duration  of  the  abuse.  The  function  re- 
turns with  restoration  of  bodily  vigor. 

The  indirect  effects  of  these  errors  are  far  more  serious 
and  enduring.  In  all  animals  the  genital  organs  commonly 
contain  bacteria  which,  so  long  as  the  animal  is  healthy, 
may  insidiously  multiply  at  a  rate  barely  to  maintain  their 
status.  When  for  any  reason  the  vigor  of  the  animal  is 
lowered,  the  genital  tract  participates  in  the  depression  and 
bacteria  multiply  and  rapidly  increase  in  virulence.  Soon 
permanent  injury  of  essential  structures  may  occur,  and 
reproduction  becomes  difficult  or  impossible.  At  one  time 
there  was  much  said  about  "fatty  degeneration"  of  the 
genital  organs  as  a  bar  to  reproduction  in  fat  animals.  I 
know  of  no  adequate  ground  for  such  an  assertion.  In  most 
animals  the  genital  organs  are  among  the  last  to  act  as  de- 
positories for  fat.  A  notable  exception  is  the  bitch,  in 
which  the  uterine  ligaments  are  loaded  with  fat,  but  these 
are  not  essential  and  the  fundamental  organs  are  not  visibly 
involved. 

As  knowledge  of  the  diseases  of  the  genital  organs  ad- 
vances, the  belief  in  the  direct  influence  of  food,  work,  and 
housing  recedes,  but  their  indirect  influence,  through  the 
general  lowering  of  vigor  and  a  correlatively  increased  viru- 
lence of  bacteria  present,  comes  into  greater  prominence. 
The  proper  nutrition,  housing,  and  physical  exercise  of 
breeding  animals  is  one  of  the  great  fundamentals  in  the 
problem  of  reproduction,  because  the  vigor  which  these  in- 
duce constitutes  an  invaluable  armor  against  the  extension 
of  infection. 

E.    Excessive  Sexual  Use 

The  number  of  copulations  which  a  male  animal  can  oll'oc- 
tively  perform  is  an  important  (luestion  for  the  bretuler.     It 


Excessive  Sexjial  Use  201 

probably  varies  greatly  with  different  individuals.  Natu- 
rally, the  povv^er  of  a  male  does  not  depend  so  much  upon 
the  number  of  females  witTi  vv^hich  he  is  expected  to  copu- 
late as  upon  the  number  of  copulations  essential  to  produce 
fertilization.  It  has  been  determined  by  careful  investiga- 
tion that,  when  the  number  of  copulations  during  a  given 
day  is  increased,  the  abundance  of  spermatozoa  in  the  semen 
rapidly  decreases  and,  if  this  service  is  pushed  too  far,  the 
spermatozoa  fail  almost  entirely,  causing  an  interruption 
of  the  fertility  of  the  animal.  Much  will  depend  upon  the 
age  and  vigor  of  the  male  animal. 

Zschokke  states  that  80  to  100  cows  may  be  bred  to  a 
single  bull  when  the  animal  is  kept  confined  and  his  service 
somewhat  regulated  by  the  breeder  but,  if  allowed  to  con- 
sort with  the  cows  at  pasture,  not  more  than  50  should  be 
allowed.  In  the  western  range  country  of  America,  the  al- 
lotment is  very  much  smaller  and  it  is  considered  safer  that 
there  be  one  bull  to  each  20  or  25  cows.  This  is  necessitated 
largely  by  the  fact  that,  during  the  principal  breeding  sea- 
son, the  bulls  have  not  yet  fully  recovered  their  vigor  from 
the  long  and  trying  winter  with  scant  food  supply.  Zschokke 
further  holds  that  the  bull  should  not  be  allowed  to  serve 
more  than  three  cows  in  any  one  day  and  that,  under  such 
conditions,  there  should  be  one  or  two  days  per  week  of 
complete  rest. 

Many  horse-breeders  apply  a  similar  standard  in  the  use 
of  stallions.  The  total  number  of  females,  however,  may 
be  greatly  increased  if  the  service  is  distributed  throughout 
the  year.  Noted  stallions,  it  is  claimed,  have  served  suc- 
cessfully, and  without  apparent  injury,  two  or  three  hun- 
dred mares  during  the  year,  but  in  such  cases  the  service  was 
evenly  distributed  over  the  entire  period. 

Zschokke  draws  attention  to  the  erroneous  belief  that  a 
long  abstinence  from  coition  serves  to  store  up  a  large 
amount  of  semen,  which  will  answer  for  a  series  of  copula- 
tions. There  is  no  reservoir  for  such  purpose,  and  all  sper- 
matozoa which  may  be  formed  and  not  used  in  copulation 
soon  disintegrate  and  are  expelled  or  absorbed. 

Excessive  sexual  use  is  largely  a  comparative  term,  in- 


202  Diseases  of  the  Genital  Organs 

dicative  of  a  relative  over-use  under  existing  environment. 
There  is  no  question  but  that  a  breeding  male  may  be  readily 
over-used  and  that  such  is  a  frequent  occurrence,  but  more 
commonly  the  use  is  relatively  excessive  because  of  bad  man- 
agement, where  proper  handling  of  the  male  would  enable 
him  to  make  the  number  of  services  demanded,  safely  and 
efficiently. 

My  belief  is  that  most  males  are  called  upon  to  copulate 
too  frequently.  The  most  hygienic  rule  for  reproduction  in 
the  higher  mammals  is  monogamy,  and  any  departure  from 
that  ideal  is  necessarily  at  some  peril.  Since  great  sires 
which  have  cost  heavily  are  expected  to  repay  their  owner 
by  begetting  a  large  number  of  highly  valuable  young,  poly- 
gamy is  crowded  to  its  limit,  and  beyond.  There  are  two 
fundamental  facts  bearing  upon  sex  hygiene  which  every 
breeder  should  know  and  heed.  Most  breeding  animals  of 
both  sexes  carry  important  infections  in  their  genital  tracts, 
and  coitus  stimulates  and  heightens  genital  infections.  The 
number  of  copulations  which  a  bull  or  stallion  may  safely 
perform  depends  first  upon  the  degree  of  infection  or  dis- 
ease in  his  genital  organs,  and,  second,  upon  his  general 
health  and  vigor.  While  many  accounts  are  published  of 
the  great  numbers  of  copulations  made  by  various  bulls  or 
stallions,  or  the  large  number  of  progeny  to  their  credit, 
they  constitute  an  infinitesimal  proportion  of  the  total. 
Clinically  we  observe  bull  after  bull  breaking  down  genitally 
under  what  would  appear  to  be  very  moderate  use.  Ad- 
mittedly the  infection  was  probably  there  already  but  the 
repeated  copulations  served  to  vitalize  it  and  establish  seri- 
ous disease,  precisely  as  coitus  intensifies  syphilis  and  gonor- 
rhea. Moderate  work  of  the  male  during  the  breeding  sea- 
son is  not  injurious,  but  favorable.  It  is  a  constant  observa- 
tion that  a  male  breeding  animal  which  is  regularly  exer- 
cised or  moderately  worked  is  capable  of  rendering  a  greater 
number  of  effective  services  than  one  which  is  closely  con- 
fined. 

Some  writers  condemn  such  foods  as  oil  cake  and  malted 


Onanis?n,  or  Masturbation  203 

grain  for  the  male  and  prefer  the  various  grains,  especially 
oats,  barley,  peas  and  beans  in  moderate  quantity.  To  these 
should  be  added  hay  and  grass  in  sufficient  amount.  Roots, 
tubers,  meal  and  molasses  are  not  considered  essential  as  a 
part  of  the  food  supply  for  breeding  males,  but  may,  by  aid- 
ing in  the  maintenance  of  a  good  state  of  digestion,  con- 
tribute to  the  general  vigor. 

The  feeding  of  salt  has  long  been  regarded  as  important 
for  maintaining  fertility,  and  some  have  superstitiously  ac- 
corded it  a  prominent  place,  but  it  can  not  act  directly  and 
serves  merely  to  favor  fertility  indirectly  by  aiding  diges- 
tion and  assimilation. 

Apparently  some  believe  that  a  male  breeding  animal  re- 
quires a  different  kind  of  food  from  the  female.  Funda- 
mentally that  is  absurd,  but  when  a  bull  is  kept  absolutely 
confined  and  is  wholly  idle  physically,  he  requires  less  food 
per  unit  of  body  weight  than  a  cow  which  is  yielding  a  lib- 
eral quantity  of  milk  and  probably  gets  some  exercise  daily 
in  the  open  field  or  paddock.  The  feeding  needs  to  be  ad- 
justed the  same  as  it  would  be  between  a  cow  which  is  milk- 
ing heavily  and  another  which  is  dry. 

F.    Onanism,  or  Masturbation 

Masturbation,  as  a  cause  of  sterility,  is  mentioned  chiefly 
in  the  stallion  and  the  bull.  It  is  said  to  be  very  common  in 
improperly  kept  stallions.  Spinola  (Handbuch  der  spec. 
Pathol.  1858,  II  Bd.)  records  this  vice  in  the  bull. 

In  the  stallion  there  is  an  erection,  the  penis  is  moved  up 
and  down,  imitating  coitus,  and  finally  ejaculation  occurs. 
In  the  bull,  the  ejaculation  is  induced  by  an  erection  and 
the  alternate  protrusion  and  withdrawal  of  the  penis.  This 
is  generally  seen  in  idle  males  which  are  closely  confined, 
over-fed,  and  sparingly  used  for  breeding,  and  in  racing 
stallions  when  sexual  debility  is  brought  about  by  hard 
work.  It  is  undetermined  whether  the  vice  causes  the  im- 
potence or  the  sexual  weakness  induces  the  masturbation. 

Correction  may  be  brought  about  by  such  feeding,  exer- 
cise and  other  care  as  will  maintain  the  general  vigor  of  the 


204 


Diseases  of  the  Geyiital  Or^ajis 


animal.  Moderate  work  or  exercise  and  judicious  feeding, 
or,  in  animals  which  can  not  be  worked  or  artificially  exer- 
cised, the  allowance  of  freedom  in  a  commodious  paddock — 
still  better,  in  a  properly  enclosed  pasture — tends  largely 
to  prevent  or  cure  the  vice.  Once  the  habit  has  become  fixed, 
it  should  be  prevented  by  a  shield  so  arranged  as  to  cause 
pain  whenever  the  penis  is  protruded.  It  is  a  vice  of  idle- 
ness and  debility,  and  any  and  all  remedies  must  fail  in 
their  aim  until  the  return  to  normal  vigor  is  attained. 


Chapter   VII 
COITAL  INJURIES 

In  the  wild  state,  severe  and  fatal  battles  between  rival 
males  are  not  infrequent  and  the  same  prevails  to  some  de- 
gree among  domesticated  animals,  although,  as  a  general 
rule,  if  several  males  are  kept  together  they  lose  much  of 
their  combativeness.  I  have  seen  an  instance  of  a  fatal 
fray  between  two  rams  which  had  been  regularly  kept  to- 
gether. 

When  a  strange  male  wanders  into  a  herd  or  group  of  fe- 
males with  which  a  male  is  regularly  consorting,  there  is  at 
once  a  determined  fight  between  the  two,  which  ends  only 
with  one  or  the  other  becoming  vanquished.  In  these  bat- 
tles, injuries  of  the  most  diverse  character  occur,  according 
to  species  and  chance.  The  only  method  of  prevention  is  the 
proper  confinement  of  male  animals.  In  most  countries 
there  are  laws  against  the  running  at  large  of  male  animals 
but  these  are  not  enforced  against  carnivora.  This  excep- 
tion should  be  overcome  by  the  confinement  of  all  females. 

There  is  further  danger  to  the  male,  especially  horses  and 
cattle,  of  injuries  in  attempting  to  escape  from  or  break 
into  enclosures  in  order  to  reach  females.  The  appearance 
of  a  female  in  estrum  near  the  enclosure  of  a  male  causes 
him  to  make  violent  attempts  to  escape  from  his  confinement 
and  reach  the  female.  Consequently  it  is  important  that  en- 
closures intended  for  the  confinement  of  male  breeding  ani- 
mals should  be  especially  secure  and,  as  far  as  possible,  all 
elements  avoided  in  their  construction  which  would  endan- 
ger the  animal  in  an  effort  to  escape. 

In  the  preparations  for  copulation  there  is  little  danger 
except  in  case  of  horses.  Breeding  customs  and  conven- 
ience bring  into  the  procedure  a  period  of  "trying"  or  "teas- 
ing" of  the  mare  by  the  stallion,  to  determine  the  existence 
of  estrum  and  bring  about  the  desired  degree  of  sexual  ex- 
citement before  permitting  an  attempt  at  copulation.  In 
this  act  there  are  numerous  dangers,  especially  to  the  stal- 
lion. 


2o6  Diseases  of  the  Genital  Organs 

It  is  desirable,  if  not  frequently  essential  to  safety,  that 
special  conveniences  for  restraint  be  provided  for  this  pur- 
pose. They  should  consist  ordinarily  of  a  strong,  solid  wall 
about  three  feet  high  and  ten  to  twelve  feet  long,  with  a 
rather  broad  and  rounded  top.  The  chief  object  of  the  struc- 
ture is  the  avoidance  of  kick  wounds  which  may  be  inflicted 
upon  the  stallion  by  the  mare.  To  this  end  it  should  be 
merely  of  sufficient  height  to  guard  against  such  an  acci- 
dent and  sufficiently  resistant  that  the  mare  can  not  kick 
through  it.  A  single  pole  to  separate  the  stallion  and  the 
mare  is  insecure  and  hazardous,  as  either  may  kick  through 
beneath  it  and  injure  the  other. 

It  is  highly  essential  that  the  top  of  the  structure  be 
rounded,  smooth,  and  free  from  projections.  Either  the 
mare  or  stallion  may  get  beyond  the  control  of  the  groom 
and  kick  or  leap  upon  the  structure.  The  wall  should  be  low 
enough  that  either  animal,  getting  upon  it  by  rearing  or 
kicking,  may  readily  free  itself  without  injury.  I  once  at- 
tended a  stallion,  which,  having  passed  beyond  the  control 
of  the  groom,  reared  to  mount  the  mare  and  became  im- 
paled upon  a  projecting  post  at  one  end  of  the  structure, 
causing  a  serious  hernia  and  almost  eventration.  Posts 
should  not  extend  above  the  top  of  the  structure  or,  doing 
so,  should  continue  so  high  as  to  make  injury  in  this  manner 
impossible. 

A.    Kicks  and  Fractures 

When  this  preparatory  period  has  been  passed  and  copula- 
tion has  been  decided  upon,  there  arise  fresh  dangers  to  the 
stallion  from  kicks  by  the  mare  while  approaching  her  or  in 
the  act  of  mounting.  Two  methods  of  avoiding  accidents 
at  this  point  are  used — without  and  with  hobbles.  In  the 
first  method,  when  both  stallion  and  mare  are  well  broken 
and  controllable  and  competent  grooms  have  each  well  in 
hand,  the  stallion  should  be  caused  to  approach  the  mare's 
head,  and  then  allowed  to  mount  from  the  side  instead  of 
from  the  rear.  If  both  are  kept  well  in  hand,  any  attempt 
to  kick  on  the  part  of  the  mare  should  be  at  once  counter- 


Kicks  and  Fraclurcs  207 

acted  by  vigorously  drawing  her  head  toward  the  stallion, 
thus  turning  her  heels  from  him.  When  coition  has  been 
completed  and  the  stallion  is  dismounting,  the  same  rule 
should  constantly  be  applied  and  the  mare  at  once  caused  to 
face  the  stallion  in  order  to  avoid  kicks. 

Owners  of  valuable  stallions  generally  prefer  to  obtain 
yet  greater  security  by  the  application  of  hobbles.  Two 
forms  are  used,  of  which  there  are  numerous  varieties.  By 
one  plan,  a  hobble  is  buckled  about  each  hind  pastern  and 
to  each  hobble  is  attached  a  rope  of  sufficient  length,  the  two 
free  ends  of  which  are  carried  forward  between  the  fore- 
legs and  securely  tied  to  a  strong  collar  or  carried  upward 
on  either  side  of  the  neck  and  tied  on  the  top  sufficiently 
tightly  to  prevent  the  mare  from  kicking  backward  any  ap- 
preciable distance.  By  the  second  plan,  the  hobbles  are  at- 
tached to  the  hocks  instead  of  the  pasterns.  In  this  case, 
each  hobble  is  branched ;  one  portion  of  each  is  attached 
above  and  the  other  below  the  hock  of  each  hind  leg,  and  by 
ropes  or  straps  fixed  forward  the  same  as  in  the  first.  The 
latter  plan  possesses  some  points  of  superiority :  the  mare  is 
not  so  liable  to  injure  herself  by  becoming  entangled  in  the 
ropes,  and  the  stallion  is  probably  also  exposed  to  less  dan- 
ger of  getting  his  foot  caught  in  the  securing  apparatus. 
Whatever  the  form  of  breeding  hobbles  or  other  confining 
apparatus,  they  should  be  secure  and  strong.  Nothing  can 
well  be  more  dangerous  for  the  breeding  stallion  than  weak 
hobbles  which  lead  to  a  false  feeling  of  security  and  throw 
the  otherwise  careful  groom  off  his  guard.  I  was  called  to 
attend  a  valuable  stallion  suffering  from  a  compound  tibial 
fracture,  the  result  of  a  kick  during  attempted  copulation. 
Because  the  mare  was  not  properly  in  estrum,  or  for  other 
reason,  she  was  unexpectedly  ill-natured.  When  the  stal- 
lion was  attempting  to  mount  she  commenced  to  kick,  the 
old  hobbles,  in  which  the  owner  of  the  stallion  had  trusted, 
gave  way,  and  the  fatal  accident  at  once  followed.  The 
breeder  should  never  trust  partly  to  hobbles  and  partly  to 
the  gentleness  of  the  mare  or  good  luck.  If  hobbles  are  to 
be  trusted  at  all,  the  breeder  should  know  that  they  are  so 


2o8  Diseases  of  the  Genital  Organs 

strong  that  no  mare  can  break  them,  always  allowing  a  safe 
margin  of  strength  beyond  that  considered  essential,  and 
that  the  fastenings  are  secure  in  every  detail,  making  slip- 
ping or  accidental  detachment  impossible. 

If  accidents  are  to  be  avoided,  it  is  highly  important  that 
the  mare  is  properly  in  estrum  and  that  she  is  not  frightened 
or  angered.  Gentleness  and  patience  in  the  handling  of  both 
stallion  and  mare  and  postponing  copulation  until  the  proper 
moment  are  always  essential  elements  of  safety  in  breeding. 
Some  breeders  place  a  twitch  upon  the  mare's  nose  until  the 
stallion  has  safely  mounted  her.  Much  of  the  danger  arises 
through  the  lack  of  ability  upon  the  part  of  the  groom  to 
diagnose  estrum.  Some  grooms  think  when  a  mare  crowds 
against  the  teasing-pole  and  urinates,  she  is  in  estrum.  when 
as  a  matter  of  fact  she  is  angry.  A  groom  should  learn 
that  a  mare,  not  in  estrum  at  all,  when  confined  to  be 
teased  by  a  stallion  and  unable  to  get  away,  will  crowd  to- 
ward him,  squat,  and  expel  small  quantities  of  urine  simply 
as  an  expression  of  anger  (a  gelding,  when  tightly  confined, 
occasionally  gives  vent  to  his  anger  by  a  characteristic 
neigh  and  the  expulsion  of  urine  in  small  quantities).  If 
opportunity  offers,  such  a  mare  will  kick  viciously.  Some 
stallions  are  so  poorly  broken  that  they  rush  at  a  mare  vio- 
lently and,  if  opportunity  is  given  her,  she  will  kick  from 
fright  in  self-defense.  The  proper  knowledge  on  the  part 
of  the  groom,  enabling  him  to  diagnose  estrum.  and  the 
proper  control  of  the  stallion,  are  prime  essentials  to  safety. 

In  breeding  mares  to  jacks,  it  is  customary  to  place  the 
mare  in  a  pit  where  she  is  closely  confined  and  rests  upon  a 
plane  a  foot  or  more  lower  than  that  upon  which  the  jack 
stands.  This  not  only  gives  an  advantage  to  the  compara- 
tively small  male  by  affording  him  an  elevation,  but  also 
secures  him  against  kicks  from  the  mare,  a  highly  essential 
precaution  because,  since  the  mare  ordinarily  resents  copula- 
tion with  the  ass,  the  act  is  largely  in  the  nature  of  rape. 

Disparity  in  size  is  a  common  cause  of  fractures  in  cattle 
of  both  sexes.  When  a  young  bull  attempts  to  copulate  with 
a  large  cow,  he  is  liable,  at  the  moment  of  the  sudden  t'()i)u- 


Kicks  and  Fracfjires  209 

latory  thrust,  to  lift  his  feet  entirely  from  the  ground,  so 
that  they  glide  forward,  he  falls  backward,  and  may  break 
his  spine  in  either  dorsal,  lumbar,  or  sacral  region.  In  one 
case  brought  to  my  attention,  a  similar  accident  occurred  to 
a  cow  which,  being  in  heat,  mounted  one  of  her  mates, 
slipped,  fell,  and  fractured  her  spine  so  that  she  had  to  be 
destroyed.  The  danger  of  falling  when  the  ground  is  slip- 
pery or  copulation  is  undertaken  upon  a  concrete  or  other 
smooth  floor,  is  to  be  obviated  by  the  removal  of  the  causes. 
In  females  mated  with  too  large  a  male,  fractures  of  the 
spine,  pelvis,  and  limbs  occur.  The  danger  is  greatly  ag- 
gravated by  slippery  or  uneven  ground  or  by  other  unfavor- 
able surroundings.  Injuries  to  the  female  because  of  the 
great  weight  of  the  male  are  not  rare  though  far  less  com- 
mon than  one  would  be  inclined  to  expect  when  the  disparity 
in  size  is  considered.  It  is  not  rare  to  see  females  served  by 
males  two,  three,  or  more  times  as  heavy,  and  yet  escape  in- 
jury. In  the  smaller  species,  as  the  pig  and  dog,  the  female 
can  quite  readily  drop  to  the  ground  under  excessive  weight 
and  escape  injury,  but  in  the  cow  and  mare  there  is  danger 
of  serious  injury  when  the  weight  of  the  male  becomes  too 
great.  Fractures  from  this  source  are  most  common  in 
cattle  and  generally  the  result  of  a  fall  at  the  moment  the 
bull  makes  the  violent  copulatory  thrust.  Some  breeders 
overcome  this  danger  by  using  a  breeding  rack  or  cage,  as 
described  above,  so  that  the  heifer  can  not  be  forced  for- 
ward and  down.  Each  side  of  the  rack  presents  a  shelf 
upon  which  the  fore  feet  of  the  bull  rest,  preventing  his  en- 
tire weight  from  falling  upon  the  heifer.  Sometimes  an 
awkward  helper  holds  the  head  of  the  cow  to  one  side  and, 
when  she  moves  forward,  draws  firmly  on  the  halter,  bend- 
ing her  head  sharply  to  one  side  and  causing  her  to  fall. 
Either  she  should  be  left  free  or  any  restraint  should  be  ex- 
erted by  two  men,  one  on  either  side,  thus  pushing  directly 
backward.  Nymphomaniac  cows  suffer  frequently  from  pel- 
vic fractures,  which  will  be  discussed  under  Cystic  Degen- 
eration of  the  Ovaries.  In  one  instance  a  heifer  of  about 
five  months  and  weighing  about  400  pounds  was  served  by 


2IO  Diseases  of  the  Genital  Organs 

a  bull  weighing  2000  pounds  and  suffered  a  fracture  of  the 
pelvis.  The  injury  was  not  sufficiently  serious  to  prevent 
her  giving  birth  in  due  time  to  a  calf.  In  another  instance, 
a  sucking  filly  was  mounted  by  a  large  stallion  which  had 
accidentally  broken  into  a  field  with  her,  causing  dislocation 
of  the  sacro-iliac  articulation  on  one  side  and  fracture  of 
the  iliac  shaft  on  the  other,  rendering  her  useless  for  labor. 
She  was  bred  at  two  years,  and  destroyed  at  three  years, 
because  of  irremediable  dystocia. 

It  is  desirable  that  young  females  which  come  in  estrum 
very  early  in  life  should  be  securely  segregated  from  mature 
males,  not  alone  because  of  the  undesirability  of  very  early 
breeding,  but  in  order  to  avoid  serious  injuries  from  dis- 
parity in  size.  It  is  also  essential  to  remember  that  a  male 
breeding  animal  regularly  confined,  in  case  of  accidental 
escape,  will  attempt  rape  upon  the  most  immature  young, 
as  in  the  foregoing  case,  with  serious  or  fatal  results. 

The  violent  copulatory  thrust  of  the  bull  occasionally' 
causes  a  fracture  of  the  base  of  the  tail  or  the  caudal  end  of 
the  sacrum.  I  have  observed  it  most  frequently  in  Jerseys, 
perhaps  because  the  sacrum  is  relatively  smaller  and  less 
resistant  than  in  other  breeds.  It  seems  to  occur  at  the  mo- 
ment of  the  copulatory  thrust.  So  far  as  known,  it  is  not 
subject  to  remedy.  The  result  is  usually  caudal  paralysis, 
with  a  lateral  curvature  of  the  tail  and  caudal  end  of  the 
sacrum,  disfiguring  the  cow  and  destroying  the  protective 
value  of  the  tail  against  flies,  without  otherwise  injuring 
the  animal. 

B.    False  Copulation 

False  copulation,  or  entrance  of  the  penis  into  the  anus 
instead  of  the  vulva,  is  possible  in  most  domestic  animals. 
Harms  records  it  as  occurring  in  the  mare,  cow  and  sow.  I 
have  observed  it  only  in  the  mare  and,  in  all,  four  times, 
though  I  have  known  of  numerous  other  instances.  It  is  by 
no  means  rare  and  is  highly  dangerous.  Its  causes  are  va- 
rious, but  it  is  probably  due  largely  to  resistance  on  the  part 
of  the  female.     Sometimes  a  female  is  thought  to  be  in  es- 


False  Copulation  2 1 1 

trum  when  she  is  not.  Perhaps  she  has  been  in  estrum  an 
hour  or  two  before  and  the  owner  or  person  in  charge  be- 
lieves it  best  to  use  forcible  restraint  in  order  that  copula- 
tion may  occur.  Some,  erroneously  believing  that,  when 
estrum  fails  to  appear  at  the  expected  date,  it  may  be 
brought  about  by  rape,  proceed  to  force  coitus.  Coition  is 
safe  only  when  estrum  is  present  in  the  proper  degree.  The 
mare  has  ample  power  to  close  the  vulva  against  the  ready 
entrance  of  the  penis,  thus  causing  it  to  glide  upward  and 
forward  against  and  into  the  anus,  which  opening  may  be 
more  readily  forced. 

The  accident  is  also  invited  in  aged  cows  or  mares  with 
pendulous  abdomen  in  which  the  tension  upon  the  rectum 
draws  the  anus  and  superior  commissure  of  the  vulva  down- 
ward and  forward,  thereby  causing  the  vulvar  opening  to 
approach  the  horizontal  instead  of  the  perpendicular.  The 
penis  then  tends  to  glide  forward  and  slightly  upward  over 
the  oblique  vulvar  opening,  to  strike  against  the  inferior 
surface  of  the  tail  and  become  deflected  into  the  anus.  It 
may  be  purely  accidental.  Harms  thinks  it  may  result  from 
smallness  of  the  female.  All  cases  I  have  observed  have 
been  in  mares  of  medium  or  large  size. 

The  extent  of  the  injury  varies.  Apparently,  the  acci- 
dent may  cause  little  or  no  injury  in  some  cases,  though,  of 
those  which  are  brought  to  the  attention  of  the  veterinarian, 
a  large  proportion  are  fatal.  The  extent  of  the  lesions  will 
vary  according  to  the  size  of  the  penis,  the  violence  of  the 
copulatory  act,  and  the  quantity  and  character  of  the  feces 
in  the  posterior  portion  of  the  rectum.  Should  the  rectum 
be  quite  empty  or  filled  only  with  pultaceous  feces,  as  in  a 
cow,  or  in  a  mare  on  green  food,  the  penis  may  force  its 
way  along  in  the  bowel  unless  it  is  caught  in  the  folds.  If 
the  rectum  is  impacted  with  dry  feces,  as  is  usually  the  case 
in  the  mare,  the  penis  is  deflected  and  tends  to  pass  through 
the  rectal  walls.  The  rupture  may  occur  either  into  the 
peritoneal  cavity  or  into  the  periproctal  connective  tissue. 
In  the  former  case,  in  the  mare,  the  opening  is  so  great  that 
feces  drop  at  once  into  the  peritoneal  cavity  and  cause  pro- 


212  Diseases  of  the  Genital  Organs 

found  irritation.  No  sooner  has  the  stallion  dismounted 
than  the  mare  trembles,  looks  anxiously  at  her  sides,  may 
pass  some  feces  and  blood,  moves  uneasily,  and  may  lie 
down,  but  does  not  roll  violently.  The  pulse  is  rapid  and 
weak,  the  breathing  is  shallow  and  quickened,  the  abdomen 
is  held  rigid,  and  the  patient  looks  tympanitic.  The  symp- 
toms resemble  in  many  particulars  those  of  rupture  of  the 
stomach.  The  diagnosis  is  readily  made  by  manual  explora- 
tion per  rectum,  since  the  hand  passes  easily  out  through 
the  rupture  into  the  peritoneal  cavity.  In  one  of  my  cases 
of  rupture  into  the  peritoneal  cavity,  the  mare  lived  some 
eight  hours ;  in  another,  less  than  four  hours. 

Not  all  cases  lead  to  rupture  into  the  peritoneal  cavity.  In 
one  instance  under  my  observation,  in  an  old  brood  mare, 
no  history  of  injury  was  obtainable,  and  apparently  the  rup- 
ture had  not  occurred  during  the  several  years  of  ownership 
by  her  last  proprietor.  She  died  under  symptoms  of  Colic. 
Autopsy  revealed  a  large  intra-pelvic  sac,  opening  into  the 
rectum,  which  had  been  habitually  filled  with  feces  but,  be- 
coming over-distended,  had  obstructed  the  bowel  and  caused 
a  rupture  of  the  sac  into  the  peritoneal  cavity.  It  was  al- 
most certainly  the  result  of  an  old  penial  wound. 

In  another  case  I  recognized  the  accident  at  the  time  of  its 
occurrence.  Blood  and  feces  were  voided,  and  the  perineal 
region  was  swollen.  Manual  exploration  revealed  a  large 
rent  through  the  rectal  walls  into  the  periproctal  connective 
tissue,  six  to  eight  inches  from  the  anus.  The  resulting  sac 
contained  about  two  liters  of  feces  impacted  into  the  readily 
distensible  wound.  The  feces  occupying  the  sac  and  those 
from  the  rectum  immediately  anterior  to  the  rupture  were 
carefully  removed  by  the  hand,  and  the  sac  was  cautiously 
flushed  out  with  an  antiseptic  solution.  This  method  of 
handling,  repeated  twice  daily,  along  with  restricted,  laxa- 
tive diet  and  complete  rest,  brought  about  a  prompt  recov- 
ery with  little  sacculation. 

According  to  Harms,  false  copulation  in  the  sow  is  usu- 
ally followed  by  no  more  serious  consequences  than  a  swollen 
anus,  accompanied  by  a  bloody  discharge. 


False  Copiilation  213 

In  the  mare  the  accident  is  preventable  by  ordinary  pre- 
cautions on  the  part  of  the  stallion  groom.  Service  should 
not  be  attempted  in  case  of  a  mare  not  certainly  in  proper 
estrum.  It  is  the  duty  of  the  groom  to  see  that  the  penis  of 
the  stalhon  is  properly  entering  the  vulva  of  the  mare.  If 
the  mare  is  kicking  or  otherwise  violently  resisting  the  stal- 
lion, he  should  be  promptly  withdrawn,  since  copulation  un- 
der such  circumstances  is  unwarrantedly  dangerous  for 
both  animals.  Such  violent  resistance  of  the  mare  is  some- 
times cited  by  the  groom  as  an  excuse  for  his  failure  to 
know  that  the  penis  of  the  stallion  was  being  properly  en- 
tered in  the  vulva,  but  it  is  not  valid.  The  mare  or  cow 
with  retracted  anus  should  be  placed  with  her  hind  feet  on  a 
lower  level  than  her  anterior  members,  leaving  the  ground 
upon  which  the  male  is  to  stand  at  a  higher  level  and  thus 
bringing  the  vulvar  opening  more  nearly  perpendicular.  In 
the  cow  and  sow,  the  accident  is  not  usually  preventable. 

The  prognosis  of  penial  injuries  to  the  rectum  must  be 
based  largely  upon  their  position  and  extent.  When  the 
lacerations  perforate  the  peritoneum,  allowing  feces  to  es- 
cape into  the  peritoneal  cavity,  the  injury  is  essentially 
fatal:  veterinarians  have  not  yet  succeeded  in  successfully 
handling  such  lesions.  When  the  rupture  of  the  rectal  wall 
occurs  behind  the  peritoneum  or,  occurring  more  anteriorly, 
does  not  perforate  it,  the  prognosis  is  good,  if  timely  surgi- 
cal aid  is  given,  though,  after  a  long  time,  serious  or  fatal 
results  may  follow  the  impaction  of  feces  in  the  sac  formed 
in  the  pelvic  connective  tissue.  The  pressure  of  the  feces  es- 
caping from  the  rectum  tends  constantly  to  push  the  loose 
connective  tissue  aside  and,  eventually,  to  form  a  large  sac, 
which  is  constantly  filled  with  fecal  masses. 

The  handling  in  such  cases  consists  of  gently  removing 
the  feces  from  the  sacculated  wound  cavity  in  the  pelvic  con- 
nective tissue  and  cautiously  flushing  it  out  at  least  twice 
daily  with  a  mild  antiseptic  solution.  At  the  same  time,  the 
rectum  should  be  manually  emptied  as  far  as  the  attendant 
can  reach  and  the  feces  thus  prevented  from  dropping  into 
the  sac.    The  patient  should  be  kept  at  rest  on  a  very  scant, 


214  Diseases  of  the  Genital  Organs 

laxative  diet  during  the  treatment,  until  the  rupture  is 
quite  healed,  as  it  is  highly  important  to  guard  against  ex- 
tensive sacculation  in  the  part,  which  can  be  done  only  by 
avoiding  the  accumulation  of  feces  in  it. 

In  some  instances,  the  injuries  to  the  rectum  from  the  en- 
trance into  it  of  the  penis  are  comparatively  trivial — merely 
wounds  of  the  mucosa  and  part  of  the  muscular  walls, 
with  the  passage  of  bloody  feces,  some  swelling  about  the 
anus,  and  other  slight  symptoms  of  injury,  which  readily 
pass  away  under  repeated  antiseptic  enemata. 

From  a  forensic  standpoint,  the  owner  of  the  stallion  is 
probably  always  responsible,  since  the  accident  is  preventa- 
ble with  proper  care  upon  the  part  of  the  groom.  Such  were 
the  findings  in  the  only  case  which  I  have  seen  tested  in  the 
courts. 

C.    Laceration  and  Rupture  of  the  Vagina 

The  vagina,  especially  of  the  mare,  is  not  infrequently 
lacerated  or  ruptured  by  the  penis  of  the  male.  The  size  of 
the  penis  of  the  stallion  does  not  bear  a  constant  ratio  to 
that  of  the  body,  but  is  comparatively  excessive  in  coarsely 
bred  animals  with  long  legs  and  large  heads.  Such  stallions, 
copulating  with  small  mares,  constantly  tend  to  produce 
vaginal  injuries.  Sometimes  it  is  merely  a  slight  laceration 
in  the  mucous  membrane,  which  may  cause  limited  hemor- 
rhage and  some  straining ;  sometimes  the  lacerations  in  the 
mucous  and  muscular  walls  are  extensive  and  induce  marked 
symptoms  of  wound  infection  in  the  vagina,  with  tumefac- 
tion, discharge  and  straining;  sometimes  the  vaginal  walls 
are  completely  ruptured,  with  great  danger  of  fatal  perito- 
nitis. 

In  one  instance  I  investigated,  a  series  of  injuries  was 
caused  by  a  recently  introduced  stallion,  which  had  been  put 
to  service  among  comparatively  small  mares.  Almost  every 
mare  served  by  him  exhibited  signs  of  vaginal  injury:  some 
were  severely  lacerated;  in  one  there  was  a  fatal  rupture. 
The  horse  was  found  to  be  an  overgrown,  coarse,  leggy  grade 
draft  stallion  about  eighteen  hands  high,  with  an  enormous 


Laceration  aiid  Rupture  of  the  Vagina 


215 


penis  which  would  have  been  dangerous  with  heavy  draft 
mares,  while  in  his  neighborhood  most  animals  were  of  small 
roadster  or  common  stock. 

When  such  injuries  occur,  there  is  observed  an  abnormal 
amount  of  straining  immediately  after  copulation,  with,  per- 
haps, some  discharge  of  blood  from  the  vulva.  Later,  swell- 
ing of  the  vulva  and  a  muco-purulent  discharge  may  occur. 

If  the  wound  penetrates  the  peritoneal  cavity,  septic  peri- 
tonitis is  highly  probable,  with  early  collapse  and  death. 

Injuries  to  the  mare  from  this  cause  should  be  obviated 
by  means  of  a  roll  or  padded  surcingle  encircling  the  body 
of  the  stallion  and  passing  just  in  front  of  the  sheath  in  a 
manner  to  prevent  the  penis  from  entering  the  vagina  to  its 
full  length,  the  pad  or  roll  being  adjusted  in  size  according 
to  the  case.  The  diameter  of  the  roll  should  always  be  ample, 
since  little  fear  need  be  entertained  that  preventing  the  en- 
trance of  the  entire  length  of  the  penis  will  unfavorably  af- 
fect the  results  of  copulation,  as  general  observations  show 
to  the  contrary.  In  constructing  this  roll  or  pad,  an  ordi- 
nary surcingle  may  be  used  and  a  tube  made  of  sheeting  or 
other  sufficiently  strong  material,  open  at  each  end,  which  is 
slipped  over  the  surcingle.  Padding  of  cotton,  oakum,  or 
other  material  is  then  to  be  inserted  into  the  tubular  cover- 
ing until  it  is  tightly  filled  so  that  it  presents  a  diameter  of 
4  to  8  inches  in  that  part  of  the  surcingle  to  come  in  contact 
with  the  abdominal  floor,  after  which  the  open  ends  of  the 
tube  are  to  be  secured  to  the  surcingle  and  closed  by  tying. 
When  the  stallion  is  ready  for  service,  the  surcingle  is  passed 
around  his  body  just  in  front  of  the  opening  of  the  sheath, 
and  secured  by  buckling.  In  copulation,  only  that  portion  of 
the  penis  projecting  beyond  the  roll  can  enter  the  vagina. 

Non-fatal  laceration  of  the  vagina  should  be  handled 
along  general  antiseptic  lines.  The  practitioner  should  re- 
member that  this  organ  reacts  strongly  to  irritants  and  that 
thorough  disinfection  should  be  brought  about  largely  by 
mechanical  flushing  rather  than  by  heroic  attempts  to  de- 
stroy the  micro-organisms  in  position.  , 

Coital  injuries  to  the  vaginae  of  cows  have  not  come  un- 


2i6  Diseases  of  the  Genital  Organs 

der  my  observation.  I  am  of  the  opinion  that  they  are  very 
rare.  The  vagina  of  the  cov^  is  very  long  and  elastic.  Dur- 
ing estrum  it  is  highly  lubricated  with  an  abundant,  thin 
mucus,  rendering  it  virtually  impossible  for  the  penis  of  the 
bull  to  become  caught  in  the  lateral  walls.  If  the  heifer  or 
cow  were  not  in  estrum  and  the  vagina  were  dry,  the  case 
would  be  quite  different. 

I  have  seen  a  number  of  cows  which  could  not  copulate 
without  great  peril  because  of  severe  vaginal  stricture.  Per- 
haps that  is  the  explanation  of  the  cited  instances  of  vagi- 
nal injury  by  the  penis. 

Lacerations  of  the  vagina  by  the  penis  are  also  liable  to 
occur  in  other  domestic  animals,  though  less  probable  than 
in  the  mare.  Their  symptoms,  prognosis,  and  treatment 
are  essentially  the  same. 

D.    Rupture  of  the  Uterus  by  the  Penis  of  the  Bull 

Duranton(')  states  that  in  one  instance  the  penis  of  the 
bull  passed  through  the  cervical  canal  and  ruptured  one  of 
the  uterine  cornua.  This  is  highly  improbable,  if  not  abso- 
lutely impossible.  It  is  almost  certain  that  the  real  culprit 
was  a  man,  who  had  either  committed  sadism  or  had  at- 
tempted to  ''open  the  womb". 

Veterinarians  should  be  always  on  their  guard  in  accept- 
ing accounts  of  injuries  to  the  vagina  or  uterus  of  the  cow 
by  the  penis  of  the  bull.  Many  owners  and  caretakers  have 
an  abiding  faith  in  the  efficacy  of  "opening  the  womb"  just 
before  coitus,  as  a  remedy  for  sterility,  and  not  infrequently 
are  not  publicly  proud  of  their  faith.  As  a  consequence, 
the  operation  is  often  kept  secret,  especially  if  the  layman 
has  become  frightened  because  hemorrhage  has  followed 
his  efforts.  Later,  if  disaster  follows,  the  true  history  is 
not  given  the  veterinarian.  Often  a  workman  will  under- 
take such  an  operation  without  the  knowledge  of  the  owner, 
and,  suspecting  he  has  injured  the  animal,  quite  naturally 
keeps  his  bungling  work  a  secret,  so  that  the  bull  is  blamed 
with  having  caused  the  lesions. 

'Journal  dc  Lyon,  iSSS. 


Alleged  Rupture  of  the  Urinary  Bladder  by  the  Pettis     217 

In  examining  a  sterile  heifer,  I  encountered  a  chronic, 
indurated,  cervical  abscess,  which  is  shown  in  Fig.  39.  The 
origin  appeared  perfectly  clear  to  me.  Upon  inquiry,  it 
was  at  once  admitted  that  a  man  had  attempted  to  "open" 
her  to  cure  the  sterility.  Repeatedly  I  have  observed  in- 
juries to  cervix  and  uterus  by  veterinarians. 

E.    Alleged  Rupture  of  the  Urinary  Bladder 
BY  the  Penis 

Uebele,  cited  by  Harms,  reports  that  a  heifer  died  from 
rupture  of  the  urinary  bladder  a  few  days  after  coitus. 
Any  veterinarian  who  has  passed  a  catheter  through  the 
urethra  of  a  cow  should  appreciate  the  difficulty  of  the  pas- 
sage of  the  penis  of  the  bull  through  that  narrow  canal,  ob- 
structed at  the  beginning  by  the  valve-like  cul-de-sac.  An 
ignorant  meddler,  mistaking  the  urethra  for  the  cervical 
canal,  might  cause  such  injury.  The  veterinarian  should 
take  every  possible  precaution  against  being  deceived, 
whenever  the  lesions  appear  so  removed  from  the  ordinary. 
Under  certain  abnormal  anatomic  conditions,  the  urethra 
might  well  suffer  severe  lesions  during  attempted  coitus, 
especially  when  the  lower  portion  of  the  hymen  persists. 
The  hymeneal  remnant  slopes  somewhat  upward  and  back- 
ward, forming  a  sort  of  pouch  in  the  floor  of  the  vulva, 
with  the  urethra  at  its  bottom.  The  membrane,  catching 
the  penis,  may  deflect  it  downward  into  the  urethra,  and 
either  the  penis  or  the  urethra  and  bladder,  or  all,  may  suf- 
fer injury.  But  that  is  aside  from  the  point.  The  healthy 
normal  genital  tract  of  the  heifer  or  cow  is  not  readily 
damaged  by  the  penis  of  the  bull  during  coitus.  When  such 
post-coital  injuries  are  recognized,  the  diagnosis  as  to 
cause  should  be  very  guarded.  Under  certain  conditions,  a 
false  diagnosis  might  well  lead  to  litigation,  especially  when 
a  bull  belonging  to  one  man  breaks  into  an  enclosure  where 
cows  belonging  to  another  are  kept. 

In  all  such  injuries  the  veterinarian  should  not  fail  to  give 
consideration  to  two  other  possibilities,  each  of  which  is 
more  probable  than  penial  injury — sadism  (which  see)  and 


2i8  Diseases  of  the  Genital  Organs 

meddling  by  incompetent  persons  in  an  effort  to  "open  the 
womb". 

In  the  mare,  this  accident  would  seem  more  possible  be- 
cause of  the  very  wide,  valveless  meatus,  through  which 
several  fingers  may  be  passed,  but  the  penis  of  the  stallion 
is  large  and  the  glans  very  broad.  Elsewhere  I  have  de- 
scribed a  filly  with  a  persistent,  though  perforate  hymen, 
which  deflected  the  penis  of  the  stallion  downward  and  ap- 
parently caused  a  wide  dilation  of  the  urethra  but  no  harm 
to  the  bladder. 

F.    Vaginal  Hemorrhage  Following  Coitus 

Hemorrhage  following  coitus  is  not  rare.  It  often  follows 
copulation  of  a  virgin  female,  owing  to  slight  lacerations 
of  remnants  of  the  hymen.  In  cattle,  when  the  granular 
venereal  disease  is  very  severe,  hemorrhage  in  both  sexes 
often  follows  coitus.  This  will  be  discussed  in  a  succeed- 
ing chapter.  If  stricture  of  the  vagina  is  present,  coitus  is 
always  liable  to  cause  hemorrhage.  Often  lacerations  of  the 
vagina  during  coitus,  already  cited,  cause  more  or  less  hem- 
orrhage. Tumors  of  the  genitalia  which  are  lacerated  by 
coitus  may  bleed  quite  profusely. 

G.    Urethral  Hemorrhage  in  Stallions 

Hemorrhage  from  the  urethra  following  coitus  was  ob- 
served by  me  in  a  valuable  racing  stallion.  The  patient,  a 
famous  imported  thoroughbred  in  fine  physical  condition, 
had  been  a  successful  sire.  He  was  very  vigorous  in  copu- 
lating. Without  warning,  he  suddenly  began  to  bleed  pro- 
fusely from  the  urethra  after  each  coitus.  The  act  of  copu- 
lation appeared  normal,  and  was  completed  promptly  and 
naturally.  A  moment  after  dismounting,  before  the  penis 
had  retracted,  there  was  a  sudden  gush  of  bright  red  blood, 
estimated  at  about  one  pint,  after  each  copulation. 

The  source  of  the  hemorrhage  could  not  be  determined, 
though  it  probably  emanated  from  the  pelvic  urethra,  vesi- 
culae  seminales,  prostate,  or  Cowper's  glands.   Its  cause  was 


Contusions  of  the  Neck  a7id    Withers  from  Biles  219 

not  learned.  He  was  withdrawn  from  the  stud,  kept  sexu- 
ally quiet,  exercised  freely,  and  fed  lightly.  Later  he  was 
returned  to  the  stud.  He  had  been  kept  in  sight  of  the  mare 
while  the  breeding  hobbles  were  being  applied,  during  which 
time  he  became  highly  excited.  This  was  changed  so  that 
the  mare  was  properly  shackled  before  he  was  brought  into 
her  presence.  He  was  then  allowed  to  copulate  promptly, 
before  excessive  erection  could  occur.    The  difficulty  ceased. 

H.    Contusions  of  the  Neck  and  Withers  from  Bites 

In  the  mare,  injuries  to  the  neck  and  withers  are  liable  to 
occur  from  bites  by  the  stallion  during  coitus.  This  is  proba- 
bly most  common  among  heavy  draft  stallions,  some  of  which 
are  very  rough  and  cause  more  or  less  serious  lacerations  or 
contusions,  at  times  leading  to  fistulous  withers.  There 
seems  to  be  no  means  for  breaking  the  stallion  of  the  vice. 
The  only  effective  method  of  control  is  the  application  of  a 
muzzle  prior  to  coition. 

I.    Penial  Injuries 

Injuries  to  the  penis  of  the  male  just  before,  during,  or 
after  copulation  are  by  no  means  rare.  The  penis  of  the 
stallion  is  most  liable  to  injury  from  kicks  by  the  mare  just 
as  he  mounts  or  dismounts.  The  prevention  of  such  injuries 
has  been  discussed  above.  Such  contusions  of  the  penis  dur- 
ing its  great  vascularity  in  the  breeding  season  are  very 
difficult  to  handle.  The  stallion  needs  to  be  kept  quiet  and 
free  from  sexual  excitement.  The  penis  should  be  retained 
at  rest  within  the  sheath,  by  means  of  a  suspensorium,  and 
the  resulting  local  inflammation  ameliorated  by  the  applica- 
ton  of  cooling  astringents  such  as  lead  acetate,  hamamelis, 
tannin,  belladonna,  etc.,  combined  if  necessary  with  anti- 
septics. Generally  the  patient  may  have  quiet  walking  ex- 
ercise, a  restricted  laxative  diet,  saline  laxatives,  or  in  case 
of  serious  disturbance,  prompt  cathartics  of  the  hypodermic 
alkaloidal  group  (eserin,  arecolin,  etc.). 


2  20  Diseases  of  the  Geiiital  Organs 

Lesser  injuries  to  the  penis  of  the  stallion  are  caused  by 
the  tail  hairs  of  the  mare,  pushed  into  the  vagina  by  the 
glans,  which,  being  drawn  tightly  across  the  penis,  cut  the 
organ.  This  is  to  be  prevented  by  the  stallion  groom,  who 
should  draw  the  tail  of  the  mare  aside  at  the  commencement 
of  the  copulatory  act ;  apply  a  bandage  about  the  base  of  the 
tail  extending  low  enough  to  secure  any  hairs  that  might  be 
caught  by  the  glans  penis ;  or  braid  the  hairs  of  the  tail  upon 
its  dorsal  surface. 

The  danger  of  injury  to  the  penis  of  the  bull  is  increased 
when  a  large  male  attempts  to  copulate  with  a  small  heifer, 
with  a  very  narrow  vulva  and  perhaps  important  remnants 
of  the  hymen.  The  presence  of  severe  granular  venereal 
disease  lessens  the  caliber  of  the  vulva  and  the  roughness 
caused  by  the  nodules  increases  materially  the  resistance  to 
the  entrance  and  the  two  combined,  with  the  pain  caused  by 
the  forcible  contact,  render  injury  more  probable.  Some- 
times the  penis  of  the  bull  withstands  violence  surprisingly 
well.  I  examined  a  neuter,  or  freemartin,  with  severe  lacer- 
ations of  the  vulva  and  periproctal  tissues.  The  owner  re- 
lated that,  as  the  "heifer"  would  not  come  in  estrum,  he  de- 
cided to  stimulate  its  appearance  by  causing  the  animal  to 
be  raped  by  the  bull.  (The  practice  of  raping  females  which 
fail  to  come  in  estrum  is  not  rare  amongst  a  careless,  ignor- 
ant class  of  breeders.)  The  penis  of  the  bull  had  caused 
serious  injury  to  the  neuter,  compelling  prompt  slaughter. 
The  penis  of  the  bull  escaped  known  injury. 

Coital  injuries  to  the  penis  and  prepuce  of  the  bull  are 
probably  more  common  and  vital  than  those  occurring  to 
the  genital  canal  of  the  cow.  Exposure  to  minor  injuries 
is  constant.  In  cattle  the  universal  presence  of  the  granu- 
lar venereal  disease  causes  a  constant  genital  catarrh,  which, 
escaping  at  the  inferor  vulvar  commissure,  befouls  the  vul- 
var tuft  of  hairs.  The  muco-pus  forms  hard,  dry  crusts 
upon  the  tuft.  The  sticky  muco-pus  also  catches  up  and  in- 
corporates in  the  crusts  various  foreign  bodies.  The  en- 
crusted vulvar  tuft  is  liable  to  become  caught  and  forced 


Pen ial  Injii rics  221 

into  the  vulva  alongside  the  penis,  abrading  it  and  threaten- 
ing to  transfer  to  the  abraded  parts  any  infection  included 
within  its  mass.  The  injury  can  and  should  be  prevented 
by  keeping  the  vulvar  tuft  clean  by  washing. 

In  abattoir  bulls,  the  penis  is  often  found  eroded,  owing 
to  the  withdrawal  into  the  prepuce  of  loose,  dirty  hairs  from 
the  preputial  tuft,  but  I  have  not  observed  this  in  breeding 
bulls.  Some  breeders  attempt  to  prevent  the  pulling  of 
hairs  into  the  prepuce  by  clipping  away  the  preputial  tuft. 
This  invites  another,  and  equally  important  danger  from 
the  multiple  minute  abrasions  of  the  prepuce  and  glans 
from  the  short  hair  stubs. 

"Broken  penis"  in  the  bull  is  often  reported.  It  is  be- 
lieved that  the  penis  becomes  caught  against  the  side  of  the 
vulva  or  elsewhere  and  the  animal  at  the  moment  of  making 
the  violent  copulatory  thrust,  doubles  the  organ  sharply 
upon  itself,  "breaking"  it  or  otherwise  causing  serious  in- 
jury. Sudden  and  violent  bending  of  the  erected  penis 
causes  such  injuries  to  its  tissues  that  the  "broken"  organ 
remains  curved  or  bent  at  an  angle.  That  portion  beyond 
the  point  of  injury  does  not  become  erected.  Thus  the  ani- 
mal is  rendered  useless  as  a  breeder  or  the  injury  causes 
severe  balanitis  or  inflammation  of  the  prepuce,  leading  to 
adhesions  so  that  the  organ  can  not  be  protruded.  Clini- 
cally I  have  observed  the  injury  following,  and  apparently 
due  to  coitus  by  a  large  bull  with  a  heifer.  In  one  instance, 
the  breeder  believed  the  penis  of  the  bull  had  been  injured 
in  casting  him  by  the  compression  method,  in  which  the 
noose  about  the  flank  crosses  the  penis  just  in  front  of  the 
scrotum.  I  have  cast  bulls  so  frequently  by  this  method, 
without  observing  injury,  that  I  could  not  accept  his  con- 
clusions regarding  the  cause  without  important  reserva- 
tions. The  injury  is  liable  to  pass  unnoted  for  several  days, 
until  the  bull  is  brought  out  for  breeding  and  is  found  to  be 
incapable  of  copulating,  or  capable  only  with  difficulty.  A 
narrow  vulva,  sometimes  accentuated  by  great  swelling  of 
the  vulvar  mucosa  because  of  severe  granular  venereal  dis- 


222  Diseases  of  the  Genital  Organs 

ease,  important  hymeneal  remnants,  vaginal  stricture,  or 
other  obstacles  to  the  passage  of  the  penis  into  the  vagina, 
tends  constantly  to  cause  the  penis  to  be  violently  bent,  most 
readily  at  the  base  of  the  glans,  where  the  encircling  pre- 
puce is  attached.  At  the  same  moment  the  prepuce  is  per- 
haps overstretched. 

Both  penis  and  prepuce  become  inflamed,  swollen,  and 
sensitive.  Protrusion  of  the  penis  becomes  very  difficult  or 
impossible.  Frequently  the  pain  is  too  great  to  permit  copu- 
lation. The  swelling  and  the  pain  about  the  base  of  the 
glans  are  very  marked. 

The  prognosis  is  good.  The  bull  usually  recovers  anato- 
mically and  functionally.  Exceptions  may  occur,  owing  to 
chronic  irregular  induration  of  the  corpus  cavernosum, 
which  causes  the  penis  to  become  bent  in  such  a  manner 
that  copulation  becomes  difficult  or  impossible.  Such  in- 
juries to  the  penis  are  preventable  where  the  causes  are 
recognizable  in  advance.  Once  they  have  occurred,  the 
handling  consists  fundamentally  of  sexual  rest  and  anti- 
sepsis. The  sexual  rest  should  be  as  complete  as  practicable 
without  unnecessarily  curtailing  physical  exercise.  On  no 
account  should  attempts  at  copulation  be  permitted  until  re- 
covery appears  to  be  complete.  Since  in  the  bull  the  pre- 
puce is  nearly  always  involved,  it  should  be  kept  clean.  In 
addition,  warm  douches  exert  a  favorable  action  upon  the 
inflamed  penis.  The  douche  should  consist  of  warm  physi- 
ologic salt  solution  or  a  very  weak,  warm,  antiseptic  liquid, 
as  a  0.25  per  cent.  Lugol's  solution.  The  salt  solution  douche 
may  be  repeated  twice  daily,  or  as  frequently  as  may  be  de- 
sired in  an  individual  case.  The  Lugol's  solution  can  not  as 
a  rule  be  applied  more  than  once,  or  at  most  twice  daily, 
without  causing  irritation.  If  the  parts  are  very  irritable, 
iodoform  suspended  in  oil  may  be  used  instead  of  the 
douches. 

The  best  instrument  for  applying  the  douche  is  the  soft 
rubber  catheter  seven  feet  in  length,  designed  specially  for 
this  purpose.     Or  one  may  substitute  for  this  the  rubber 


Rupture  of  the  Prepuce  223 

horse  catheter,  the  length  of  which  is  to  be  supplemented  by 
splicing  with  two  or  three  feet  of  ordinary  tubing,  attached 
to  a  hospital  irrigator.  The  catheter  should  be  cautiously 
pushed  through  the  sheath  into  the  prepuce,  the  irrigator 
elevated  one  to  two  feet  above  the  bull's  back,  the  sheath 
opening  compressed  about  the  catheter  with  the  hand,  and 
the  douching  fluid  caused  to  flow  into  the  sheath  and  pre- 
puce until  they  are  fully  distended,  when  it  should  be  al- 
lowed to  escape,  and  the  process  repeated  as  often  as  con- 
sidered expedient. 

J.  Rupture  of  the  Prepuce 

Rupture  of  the  prepuce  sometimes  occurs,  as  shown  in 
Fig.  60,  presumably  due  to  the  violence  of  the  copulatory 
thrust,  associated  with  a  narrow  vulva,  hymeneal  stricture, 
or  possibly  other  unfavorable  anatomical  condition.  How 
common  it  may  be,  I  am  unable  to  state.  My  one  example. 
Fig.  61,  is  from  the  abattoir,  and  hence  without  clinical  his- 
tory. Clinically,  rupture  of  the  prepuce  is  subject  to  defi- 
nite diagnosis  only  by  the  forcible  protrusion  of  the  penis, 
as  already  described.  It  may  be  suspected  by  a  history  of 
marked  hemorrhage  following  the  coitus  during  which  the 
lesion  has  occurred. 

A  slight  rupture  may  perhaps  recover  without  impair- 
ment of  breeding  efficiency,  but  severe  or  extensive  rupture 
probably  closes  the  breeding  career  of  the  animal,  because 
the  ruptured  parts  may,  in  healing,  become  adherent  to  the 
surrounding  framework  of  the  sheath,  incarcerating  the 
glans  penis  and  causing  permanent  and  irremediable  phi- 
mosis. 

The  prevention  of  such  injuries  is  more  important  and 
practicable  than  their  handling.  They  are  most  liable  to 
occur  in  confined  males  which  are  suddenly  brought  in  con- 
tact with  females,  not  always  in  a  proper  state  for  coition. 
The  female  may  be  nervous  or  timid  at  the  approach  of  a 
strange  male  or,  still  worse,  estrum  may  not  have  reached 
its  fullness  or  may  have  begun  to  decline  so  that  she  will  not 


224  Diseases  of  the  Genital  Organs 

stand  well,  and  owing  to  her  resistance  the  accident  may 
occur.  Slippery  or  uneven  ground  may  also  render  the  act 
insecure  and  lead  to  injuries  to  the  penis. 

Prevention  should  be  based  chiefly  upon  the  avoidance  of 
these  and  other  dangers.  With  cattle  especially,  it  is  im- 
portant that  the  female  be  properly  in  estrum,  and  that  the 


Fig.  6i— Rupture  of  Prepuce.     Bull. 

G,  Glaus;  F,  fornix  ;  RR,  rupture  of  the  prepuce  near  its  juncture 

with  the  sheath. 

ground  or  floor  of  the  enclosure  in  which  copulation  is  to 
occur  be  reasonably  even.  Zschokke  commends  (Der  Un- 
fruchtbarkeit  des  Rindes,  page  66)  service  stocks  consist- 
ing of  five  posts  upon  which  are  fixed  two  beams  which  meet 
in  front  to  constitute  an  acute  triangle,  open  at  the  base, 
into  which  the  cow  is  led  and  from  which  she  can  not  readily 
escape  or  make  any  extensive  movements. 

In  the  handling  of  such  injuries  to  the  penis,  little  can  be 
done  beyond  the  allaying  of  infection  by  means  of  antisep- 
tic douches  and  the  avoidance  of  sexual  excitement,  com- 


Strangulated  Hernia  225 

bined  with  such  local  and  general  treatment  as  would  tend 
to  control  inflammation. 

In  the  dog,  in  which,  during  copulation,  the  prominent 
glans  penis  becomes  tightly  fixed  in  the  vulva  of  the  bitch, 
the  male  may  dismount  and  turn  in  the  opposite  direction, 
thus  bending  the  penis  abruptly.  If  disturbed  by  other 
dogs  or  in  any  other  manner,  violent  dragging  upon  the 
penis  follows,  which  leads  to  injuries  of  a  more  or  less  seri- 
ous character,  chiefly  to  swelling  and  inflammation  of  the 
parts,  occasionally  followed  by  paraphimosis.  These  in- 
juries are  not  usually  observed  under  proper  breeding  ar- 
rangements, but  are  generally  seen  where  bitches  are  per- 
mitted to  run  loose  and  a  large  number  of  dogs  congregate, 
with  the  resultant  fighting. 

The  handling  of  such  injuries  to  dogs  consists  of  essen- 
tially the  same  methods  as  in  the  bull,  chiefly  disinfection. 
If  paraphimosis  results,  it  should  be  overcome.  A  local  an- 
aesthetic, with  perhaps  some  adrenalin,  may  be  applied  to 
the  swollen  glans  penis,  after  which,  with  the  aid  of  digital 
compression  or  by  means  of  an  elastic  bandage,  the  size  of 
the  congested  organ  may  be  so  reduced  that  it  can  be  pressed 
back  into  the  prepuce.  If  not,  the  margin  of  the  prepuce  is 
to  be  enlarged  by  incision  sufficiently  to  permit  the  penis  to 
return. 

K.  Strangulated  Hernia 

Copulation  is  one  of  the  commonest  causes  of  strangu- 
lated inguinal  hernia  in  the  stallion,  and  occasionally  in 
other  male  animals.  When  the  stallion  mounts  the  mare, 
the  inguinal  region  is  subjected  to  increased  pressure  from 
the  weight  of  the  abdominal  viscera.  The  position  of  the 
abdomen  is  changed  from  horizontal,  or  a  declination  down- 
ward and  forward  from  the  inguinal  ring  towards  the  dia- 
phragm, to  almost  the  perpendicular,  with  the  entire  weight 
of  the  abdominal  viscera  pressing  downwards  upon  the  pel- 
vic inlet  and  inguinal  opening.  The  pressure  is  further 
augmented  by  the  abdomen  of  the  stallion  becoming  forcibly 
15 


226  Diseases  of  the  Geyiiial  Organs 

compressed  against  the  buttocks  of  the  mare,  as  well  as  by 
the  vigorous  contraction  of  the  abdominal  muscles  during 
the  act,  all  of  which  combine  to  increase  the  intra-abdominal 
pressure  and  tend  to  force  a  small  section  of  intestine 
through  the  inguinal  ring,  where  it  quickly  becomes  strangu- 
lated unless  it  promptly  returns  to  its  proper  position  when 
the  stallion  dismounts. 

In  such  case,  soon  after  dismounting,  in  fifteen  to  thirty 
minutes,  or  even  earlier,  the  stallion  exhibits  symptoms  of 
colic,  kicks  at  his  belly,  looks  at  his  flank,  breathes  rapidly, 
sweats  profusely  and  rolls  violently.  The  agony  is  excru- 
ciating and  constant,  increasing  in  intensity,  the  sweat  be- 
coming more  profuse  until,  after  ten  to  twelve  hours  in  very 
acute  and  unrelieved  cases,  the  violence  abates,  the  body 
surface,  bedewed  with  sweat,  becomes  cold,  and  the  pulse 
rapid  and  weak  or  imperceptible,  indicating  gangrene  of 
the  incarcerated  bowel,  to  be  soon  followed  by  death. 

If  the  inguinal  region  is  carefully  examined,  a  tense  fluc- 
tuating swelling  may  be  recognized,  but  in  many  cases  the 
incarcerated  intestinal  loop  is  so  small  that  its  presence  can 
be  determined  only  by  very  careful  palpation.  Examina- 
tion per  rectum  usually  gives  more  definite  results :  the  in- 
carcerated intestine  can  be  felt  and  grasped,  making  the 
diagnosis  definite  and  final. 

The  handling  needs  to  be  prompt,  and  usually  radical,  if 
the  life  of  the  patient  is  to  be  saved,  although  spontaneous 
recovery  occurs  in  some  cases.  If  the  agony  of  the  patient 
does  not  prohibit  the  attempt,  the  operator  may  insert  his 
hand  per  rectum,  grasp  the  incarcerated  intestine,  and.  drag- 
ging gently  and  cautiously  upon  it,  attempt  its  replacement. 
At  times  this  succeeds. 

Should  this  fail,  the  animal  is  to  be  cast  in  dorsal  recum- 
bency, with  the  hind  legs  sharply  abducted,  and  the  inguinal 
region  freely  opened.  He  should  at  once  be  placed  under 
complete  anaesthesia.  The  dragging  on  the  incarcerated 
bowel  per  rectum  may  now  be  repeated,  accompanied  by 
digital  manipulation  or  compression  externally  with  the 
other  hand  or  by  an  assistant. 


Strangulated  Her7iia  227 

Failing  in  these  efforts,  herniotomy  should  be  performed 
with  the  least  possible  delay.  After  thorough  disinfection 
of  the  region,  proper  sterilization  of  hands  and  instruments, 
and  covering  the  adjacent  parts,  including  the  hind  feet  and 
legs,  with  aseptic  or  antiseptic  towels  or  napkins,  the  scro- 
tum is  to  be  freely  and  cautiously  incised  down  to  the  in- 
carcerated intestine,  after  which  the  carefully  disinfected 
and  moistened  index  finger  is  to  be  passed  up  along  the  an- 
terior side  of  the  herniated  bowel  to  the  point  of  incarcera- 
tion in  the  internal  ring.  Using  the  finger  as  a  guide,  a 
herniotome,  probe-pointed  bistoury,  scalpel,  or  such  other 
instrument  as  the  exigencies  of  the  situation  demand,  is  in- 
troduced through  the  ring  at  its  antero-external  angle  and 
the  tissues  are  sufficiently  divided,  forward  and  outward,  to 
permit  the  incarcerated  intestine  to  return.  Sterile  or  anti- 
septic gauze  is  then  introduced  into  the  wound  and  packed 
closely  against  the  internal  ring  in  a  manner  to  avoid  all 
danger  of  a  recurrence  of  the  hernia,  and  the  scrotal  wound 
is  closed  by  sutures.  The  tampon  may  be  omitted  and  deep 
sutures  taken  in  the  internal  ring,  closing  it  against  future 
hernia. 

Twenty-four  to  forty-eight  hours  later  the  antiseptic 
gauze  may  be  removed,  and  the  wound  disinfected,  closed, 
and  thereafter  left  undisturbed  or  handled  according  to  in- 
dications. If  the  strangulation  of  the  intestine  has  already 
led  to  the  necrosis  of  the  incarcerated  loop,  resection  of  the 
intestine  should  be  promptly  performed.  When  herniotomy 
is  performed,  if  there  is  doubt  concerning  the  viability  of  the 
incarcerated  loop,  after  the  inguinal  ring  has  been  freely 
dilated,  additional  intestine  may  be  drawn  out  and  the  parts 
carefully  examined.  The  intestine  should  be  kept  moist  with 
physiologic  salt  solution.  The  operation  of  resection,  be- 
longing to  surgery,  need  not  be  described  here.  The  prog- 
nosis in  herniotomy  is  good  in  properly  selected  cases. 


Chapter  VIII 
PARTURIENT  INJURIES 

A.    Lacerations  of  the  Perineum 

Lacerations  of  the  perineum  occur  in  two  distinct  ways, 
and  almost  exclusively  in  mares.  The  more  important  type 
of  laceration  of  the  perineum  is  due  to  one  of  the  extremi- 
ties of  the  fetus,  generally  a  foot,  becoming  misdirected 
during  parturition,  being  forced  up  through  the  roof  of  the 
vagina  and  floor  of  the  rectum,  and  protruding  from  the 
anus.  The  violent  expulsive  efforts  of  the  mother  drive  the 
fetus  along  and  tear  asunder  the  entire  partition  between 
the  rectum  and  the  anus  above  and  the  vagina  and  vulva 
below,  converting  the  two  posterior  openings  into  a  common 
cloaca.  The  accident  and  its  handling  have  been  fully  de- 
scribed in  the  companion  volume.  Veterinary  Obstetrics. 
It  is  referred  to  here  because,  as  a  general  rule,  if  not  prop- 
erly handled,  it  closes  the  breeding  life  of  the  animal.  The 
unhealed  tear  permits  feces  to  drop  into  the  vagina,  keep- 
ing up  a  constant  irritation  and  fecal  infection.  It  also 
renders  copulation  virtually  impossible.  If  the  cervix  and 
uterus  are  healthy,  artificial  insemination  may  succeed,  and 
if  pregnancy  ensues  the  injury  will  offer  no  impediment  to 
parturition. 

The  second  type  of  laceration  of  the  perineum  may  occur 
in  any  animal,  though  most  frequently  in  the  mare.  In  this 
type  of  laceration,  the  injury  is  due  to  overstretching  of  the 
vulva  by  the  volume  of  the  fetus.  In  almost  all  cases  the  in- 
jury occurs  at  the  superior  commissure  of  the  vulva  and  ex- 
tends obliquely  upward  to  the  right  or  to  the  left  outside  the 
anal  sphincter.  Such  lacerations  are  of  importance  princi- 
pally because  they  permit  the  superior  commissure  of  the 
vulva  to  drop  forward,  rendering  the  vulvar  opening  hori- 
zontal and  interfering  with  copulation.  Still  more  impor- 
tant, they  destroy  the  physiologic  function  of  the  vulva  as  a 
sphincter  and  as  a  barrier  to  infection,  so  that  the  vagina 


Recto-  Vaghial  Fistula  229 

tends  to  become  more  intensely  infected  than  usual,  and 
this  infection  may  extend  through  the  cervical  canal  into 
the  uterine  cavity  and  beyond. 

Consequently  it  is  of  importance  that  such  lacerations  be 
repaired  as  promptly  as  possible.  Owing  to  the  constant 
tension  of  the  muscles  and  fascia  extending  from  the  vulva 
to  the  ischial  tuberosity,  the  margin  of  the  sacro-sciatic  liga- 
ment, and  the  sacrum,  it  is  difficult  to  retain  the  parts  in 
apposition  while  healing.  Therefore  it  may  be  advisable  to 
isolate  largely,  upon  one  or  both  sides,  the  anus  and  vulva 
from  the  adjacent  structures  by  making  two  approximately 
parallel  incisions  from  above  to  below  on  either  side  of  the 
anus  and  vulva,  extending  through  the  skin  and  subcuta- 
neous tissues,  so  that  outward  tension  upon  these  can  no 
longer  exist.  After  the  injury  has  been  repaired,  the  in- 
cision will  heal  and  the  function  of  the  parts  be  restored. 

B.    Recto- Vaginal  Fistula 

Recto-vaginal  fistula,  like  the  first  type  of  ruptured  peri- 
neum, belongs  virtually  exclusively  to  the  mare.  Its  origin 
is  the  same.  An  extremity  of  the  fetus,  almost  always  a 
hoof,  pushes  up  through  the  roof  of  the  vagina  and  rectal 
floor  into  the  rectum.  The  position  of  the  deviated  member 
then  becomes  corrected,  and  birth  is  completed  without  the 
tissues  posterior  to  the  puncture  becoming  divided.  As  a 
rule,  the  erroneous  position  of  the  foot  is  probably  corrected 
by  an  attendant  who,  realizing  the  peril,  quickly  pushes  the 
foot  from  the  anus  and  rectum  back  down  into  the  vagina. 
The  opening  persists.  The  result  is  analogous  to  the  com- 
plete rupture  of  the  perineum.  Feces  drop  through  the  fis- 
tula and  cause  fecal  infection. 

The  prognosis  and  handling  are  the  same  as  for  complete 
rupture  of  the  perineum. 

C.    Lacerations  of  the  Cervix 

Lacerations  of  the  cervix  have  been  generally  ignored. 
Not  alone  have  the  parturient  lacerations  of  the  organ  been 


230  Diseases  of  the  Genital  Organs 

disregarded,  but  there  has  been  a  very  general  disregard 
for  surgical  invasion  of  the  cervix  in  a  manner  equivalent 
to  laceration.  There  has  come  down  to  the  present  day  a 
legend  of  frequent  stricture  and  induration  of  the  cervix, 
of  a  character  to  prevent  parturition,  which  may  be  relieved 
by  a  free  and  careless  dilation  of  the  canal  by  incision.  Ow- 
ing to  a  gross  and  common  misconception  with  reference  to 
the  non-dilation  of  the  bovine  cervix  at  the  time  of  parturi- 
tion, it  is  quite  habitual  to  dilate  a  perfectly  normal  cervix 
by  cutting,  when,  as  a  matter  of  fact,  the  whole  fault  lies  in 
a  paretic  uterus.  The  cervix  has  no  inherent  power  to  di- 
late, but  is  dilated  passively  by  the  contraction  of  the  uter- 
ine walls  upon  the  fetus  and  its  fluids.  Adhesions,  or  in- 
durated thickenings,  in  the  cervix  occur  with  such  frequency 
as  to  constitute  a  basis  for  the  fiction  of  the  frequency  of 
induration.  Practitioners  should  be  on  the  alert  and  re- 
member the  three  salient  facts — that  the  cervix  of  the  cow 
is  physiologically  very  rigid,  that  its  non-dilation  at  time  of 
parturition  is  almost  always  due  to  atony  of  the  uterus  from 
intra-uterine  infection,  and  that  the  part  played  by  the  cer- 
vix is  essentially  passive.  If  this  is  fully  understood,  dila- 
tion of  the  cervix  by  incision  will  not  be  rashly  applied. 

In  whatever  manner  the  laceration  or  division  of  the  cer- 
vical wall  occurs,  the  fissure  heals  neither  perfectly  nor 
readily  and  the  vaginal  opening  of  the  cervical  canal  gapes. 
Naturally  infection  of  the  cervix  follows  and  a  pernicious 
interference  with  fertility  results. 

Lacerations  of  the  cervix  should  be  repaired  as  promptly 
and  accurately  as  possible.  If  recognized  at  first,  they 
should  be  carefully  sutured  with  slow-dissolving  catgut  un- 
der the  best  available  asepsis.  When  a  persistent  fissure  in- 
terferes with  fertility,  the  vaginal  end  of  the  cervix  had  best 
be  amputated  as  far  forward  as  the  fissure  extends.  The 
technic  of  trachelectomy  is  described  later  under  ''Cervici- 
tis". 


Chapter  IX 

SODOMY  AND  SADISM 

Injuries  to  the  Genital  and  Neighboring  Organs  of 
Animals  by  Sexually  Psychopathic  Men 

It  is  of  fundamental  importance  that  veterinarians  shall 
have  in  mind  the  extremely  variable  injuries  which  may  be 
caused  to  animals  by  sexual  perverts.  Failure  to  diagnose 
these  injuries  has  been  the  common  lot  of  veterinary  prac- 
titioners. The  errors  in  the  diagnosis  of  such  injuries  mis- 
lead the  public,  tend  to  cause  a  repetition  of  the  acts  upon 
other  animals,  and  result  in  extensive  losses  to  owners,  be- 
cause under  the  shadow  of  error  the  culprit  is  not  detected, 
nor  is  any  intelligent  effort  made  at  detection.  Finally,  the 
error  is  deeply  humiliating  to  the  erring  veterinarian. 

Veterinary  literature  is  very  poor  in  this  field.  The  prin- 
cipal contributors  to  our  knowledge  have  been  GuillebeauS 
Cadiot-,  and  Eggimann'.  The  following  includes  the  more 
important  portions  of  the  contribution  of  Guillebeau. 

The  injuries  may  be  placed  under  two  headings — sodomy 
and  sadism.  Sodomy,  or  carnal  intercourse  between  man 
and  the  lower  animals,  while  highly  repulsive  to  moral  stand- 
ards and  in  sharp  conflict  with  statutory  laws,  is  generally 
of  but  scant  interest  to  veterinarians,  as  Guillebeau  points 
out,  because  no  physical  injury  follows  in  the  large  domestic 
animals  and  the  specific  venereal  infections  of  man  are  not 
transmissible  to  animals. 

Guillebeau  relates  that  in  a  remote  suburb  several  neigh- 
bors, upon  separate  mornings,  each  found  a  dead  hen  which 
had  been  left  apparently  well  the  evening  before.  The 
fourth  hen  was  presented  for  autopsy. 

1  Ueber  Verletz-ungen  der  Haustiere  durcli  sexuellpsycopathic  Meuschen. 
Von  Alfred  Guillebeau  in  Bern.  Schweizer  Archiv.  fiir  Tierheilkuude. 
XLI  Band,  1899,  page  i. 

2  Cadiot,  P.  J.  Bulletin  d.  1.   See.  Centr.  de  Med.  Vet.  vol.  50,  page  257. 

'  Eggiman,  F.,  Schweizer  Archiv.  f.  Tierheilkuude.  Band  35  (1893) 
page  103. 


232  Diseases  of  the  Genital  Orgayis 

The  well-filled  crop  and  well-developed  ^^%  in  the  oviduct 
indicated  sudden  death.  The  liver  presented  several  lacera- 
tions covered  with  blood,  and  on  its  caudal  side  between  the 
intestinal  loops  an  extensive  hematom.  The  connective  tis- 
sue of  the  groin  was  infiltrated.  The  q%^  tube  contained  a 
hard-shelled  egg.  The  cloaca  was  gaping  and  dilated  to 
21/2  cm.,  much  larger  than  normal.  Four  days  later  another 
dead  hen  was  brought  for  autopsy  by  another  neighbor.  The 
cadaver  presented  the  same  lesions,  with  the  addition  that 
the  left  tibia  was  broken  and,  yet  more  important,  two 
mammalian  spermatoza  were  found  in  the  cloaca.  The  liver 
rupture  was  apparently  due  to  the  violent  holding  of  the 
hen  to  prevent  her  escape.  Later,  in  another  locality,  an 
owner  lost  a  number  of  hens,  one  at  a  time,  at  intervals  of 
one  to  a  few  days,  and  finally  a  sick  bird  was  brought  Guille- 
beau  for  observation.  Eight  days  later  it  was  necessary  to 
kill  her.  The  autopsy  revealed  bloody  serum  and  fibrin 
clots  in  the  body  cavity,  the  liver  greatly  enlarged  and  con- 
taining large  cavities  filled  with  blood  serum,  the  intestines 
adherent.  Apparently  the  wounds  were  essentially  like  the 
foregoing,  but  not  so  severe  as  to  cause  immediate  death. 

The  incentives  to  such  an  offense  lie  in  a  great  sexual 
craving  with  a  low  moral  sense,  while  in  other  respects  the 
person  may  be  normal  or  even  bright. 

The  subject  is  without  material  veterinary  interest  be- 
yond diagnosis,  and  through  this  means  to  enable  the  owner 
to  secure  police  protection. 

Sadism,  or  that  type  of  sexual  perversion  which  leads  per- 
sons to  mutilate  the  genital  and  neighboring  organs,  is  of 
far  more  frequent  interest  to  veterinarians  and,  owing  to 
the  endless  variety  of  mutilations,  offers  extraordinary  difii- 
culties  in  diagnosis.  Many  of  the  mutilations  prove  fatal, 
and  the  pervert  is  so  persistent  in  the  perpetration  of  the 
offense  that  delay  in  diagnosis  may  cause  great  economic 
loss,  as  well  as  serious  embarrassment  to  the  veterinarian. 
Errors  in  diagnosis  have  certainly  injected  into  our  litera- 
ture some  very  mysterious  and  illogical  accounts  of  coital 
injuries.  Quite  naturally  a  sex  pervert  is  equally  or  more 
liable  to  commit  the  offense  upon  an  animal  in  estrum,  at 


Sodoniv  and  Sadism  233 

which  time  also  the  female  copulates  if  opportunity  is  of- 
fered. The  coincidence  of  physiologic  copulation  with  a 
male  of  the  same  species  and  sadism  by  a  psychopathic  man 
may,  and  undoubtedly  does,  lead  veterinarians  to  attribute 
to  coitus  injuries  which  are  highly  improbable  or  impossible 
from  that  act. 

In  one  instance  cited  by  Guillebeau,  recorded  by  Eggi- 
mann,  five  cows  and  two  heifers  in  one  establishment  were 
mutilated  in  the  vagina  and  rectum,  and  four  of  them  died. 
Two  aborted  putrid  fetuses.  The  seven  animals  had  re- 
ceived a  total  of  over  thirty  punctured  wounds,  one  animal 
alone  having  fifteen  punctures.  The  wounds  were  of  various 
depths,  about  the  diameter  of  a  goose  quill,  and  surrounded 
by  necrotic  tissue.  The  wounds  penetrated  the  peritoneal 
cavity,  the  uterus,  the  rectum,  and  the  pelvic  connective  tis- 
sues and  mutilated  the  urethra,  bladder,  and  the  urethral 
valve.  Extensive  and  fatal  hemorrhages  ensued,  as  well  as 
metritis,  vaginitis,  peritonitis,  etc.  The  culprit  was  not  dis- 
covered and  no  legal  action  taken. 

Guillebeau  records  that  in  1896,  in  Obersteg  near  Bern,  in 
an  isolated  establishment  far  back  in  the  mountains,  ten 
cattle  and  ten  goats  were  injured,  mostly  fatally.  The  depre- 
dations began  in  January,  when  the  father  of  the  culprit 
lost  two  cows,  two  goats,  and  later  two  cattle.  In  March 
two  cattle  and  six  goats  were  mutilated,  in  April  three  cattle 
and  two  goats,  and  in  May  one  heifer.  In  June  two  cattle 
belonging  to  neighbors  were  injured.  The  monetary  loss 
was  $720,  one-half  of  which  fell  upon  the  father  of  the  of- 
fender. The  last  animal  of  the  group  was  destroyed  ten 
days  after  mutilation  and  an  autopsy  made.  The  vagina 
contained  a  large  volume  of  red,  stinking  exudate.  Fistulae 
extended  from  the  vagina  forward.  Two  of  these  were  ten 
cm.  long.  One  was  fifty-five  cm.  long,  involving  wounds  of 
the  liver,  spleen,  diaphragm,  and  lung,  and  reaching  the 
region  of  the  eighth  rib,  or  about  the  middle  of  the  chest. 
The  frightful  injuries  revealed  by  the  autopsy  made  it 
clear  that  the  culprit  had  accomplished  his  designs  with  a 


234  Diseases  of  the  Genital  Organs 

stick.     The  extraordinary  resemblance  between  these  in- 
juries and  those  recorded  above  in  Langnau  was  apparent. 
The  symptoms,  in  the  cases  not  immediately  fatal,  con- 
sisted of  straining,  bloody  discharge  from  the  vagina,  swell- 
ing of  the  vulva,  and  general  weakness.     Six  months  later 
the  investigation  was  taken  up  by  Professor  E.  Hess  and 
the  culprit  detected.     He  was  a  large,   nineteen-year-old 
man,  bent  somewhat  forward,  with  a  handsome  face,  downy 
beard,  and  dangling  arms.    He  had  suffered  from  inflamma- 
tion of  the  brain  at  four  years.     His  cranium  was  small, 
and  he  was  regarded  as  idiotic.     In  school  he  could  not 
learn  and  when  grown  was  incapable  of  work  except  as  an 
assistant  in  caring  for  cattle.    Taken  into  custody,  he  con- 
fessed his  guilt  several  times  and  later  withdrew  his  con- 
fession.   He  went  about  his  misdeeds  so  craftily  that  he  had 
never  been  caught. 
The  Cases  in  Wolfikon,  Schivartzeyihach,  and  Rickenbach. 
In   March,    1894,  in   a  stable   containing  fifteen   cattle, 
eight — all  in  one  row  of  stanchions — became  ill.    Amongst 
them  were  three  calves,  one  only  a  few  days  old.    There  was 
a   bloody   vaginal    discharge,    depression,    and   peritonitis. 
Some  showed  crepitant  swelling  of  the  loins  and  croup. 
Within  a  week  four  animals  had  died  and  four  had  been 
killed.     All  were  buried  with  their  hides  on.     Fifteen  hun- 
dred kilos  of  hay  was  burned  for  fear  of  bad  contamination. 
The  guilty  caretaker  and  his  clothes  were  carefully  disin- 
fected.   The  cattle  which  had  escaped  mutilation  were  dis- 
infected and  removed  to  other  quarters.    In  two  weeks,  two 
of  the  remaining  seven  animals  became  affected,  one  of 
which  died  and  the  other  was  slaughtered.    The  remaining 
five  head  were  slaughtered  in  order  to  escape,  partially,  the 
impending  loss.     After  about  two  months,  the  tenant  pur- 
chased two  cows,  but  in  a  short  time  he  buried  one  and  re- 
turned the  other  to  the  seller.     The  same  caretaker  of  the 
cattle  was  still  in  charge.     He  purchased  goats,  which  re- 
mained well.     It  was  soon  hoped  that  the  ban  which  had 
hung  over  the  place  had  disappeared.     The  tenant  bought 


Sodomy  and  Sadism  235 

three  goats,  which  promptly  died  under  the  same  conditions 
as  the  cattle.  He  became  discouraged,  sold  his  hay  to  be 
fed  to  horses  only,  and  sold  his  farm. 

The  servant  found  employment  with  another  party  in 
Schwartzenbach.  Here,  as  in  the  preceding  place,  a  heifer, 
a  goat,  four  oxen,  and  a  cow  soon  became  ill.  Three  oxen 
were  buried.  The  flesh  of  the  other  cattle  was  used  for  food. 
The  investigator  was  struck  with  the  similarity  of  the  mu- 
tilations of  the  sexual  organs  with  those  observed  in  Wolf- 
ikon.  A  Capuchin  monk,  evidently  a  good  judge  of  men, 
when  consulted,  advised  the  discharge  of  the  servant.  The 
losses  became  noised  about  the  neighborhood  and  were  at- 
tributed to  the  young  man  who  had  cared  for  the  cattle.  On 
November  12,  1895,  he  obtained  a  new  position  in  Ricken- 
bach,  not  far  away  from  his  previous  place.  Fourteen  days 
later,  a  cow  cared  for  by  this  man  sickened  like  the  preceding 
and  had  to  be  destroyed.  Autopsy  revealed  a  finger-sized 
fistulous  wound  in  the  rectum,  two  blood-covered  lacerations 
in  the  vagina,  and  hemorrhage  into  the  peritoneal  cavity. 
On  the  next  day  a  cow  died  suddenly  from  symptoms  of 
vaginal  and  rectal  hemorrhage.  A  third  animal  had  to  be 
destroyed  on  November  29.  In  the  vagina  only  one  perfor- 
ating wound  was  found,  but  in  the  rectum  thirty-five,  six  of 
which  were  perforating.  A  fourth  animal  injured  would 
probably  recover.  The  servant  was  discharged  and  a  few 
days  later  arrested.  At  first  he  denied  his  guilt,  but  later 
confessed  that  he  had  caused  the  injuries  by  forcing  a  stick 
into  the  rectum  and  vagina  and  pushing  it  back  and  forth 
until  the  animal  bled.  The  culprit  was  twenty-four  years 
old  and  a  capable  worker  in  stable  and  field.  He  was  good- 
natured  but  represented  as  wanting  in  judgment.  In  Wolf- 
ikon,  the  scene  of  his  first  crimes,  he  was  three  years  in  ,one 
position,  but  apparently  he  had  come  to  sexual  maturity 
very  late  and  part  of  the  period  of  service  preceded  this. 
His  teacher,  the  local  pastor,  and  the  alienist  who  observed 
him  after  arrest  regarded  him  as  of  very  low  intelligence. 
The  size  of  the  cranium  was  below  normal.    In  the  hearing. 


236  Diseases  of  the  Genital  Organs 

the  young  man  showed  some  of  the  talents  of  a  trader.  He 
had  at  his  command  about  5000  francs  and  criticized  the 
reckoning  of  damages.  In  recent  years,  while  feeding,  milk- 
ing, and  grooming  the  cows,  he  had  had  frequent  erections, 
fits  of  excitement,  and  delusions.  At  first  he  merely  forced 
his  hand  into  the  posterior  body  openings  of  his  charges; 
later  he  used  a  stick,  always,  according  to  his  statement, 
under  the  pressure  of  a  dark,  powerful,  inner  craving  at 
times  when  he  also  suffered  from  sleeplessness,  sweating, 
dysuria,  and  erections.  He  seemed  conscious  of  the  wrong, 
but  powerless  to  resist  his  cravings.  He  was  adjudged  ir- 
responsible, but  made  to  pay  as  far  as  possible  for  the  losses 
caused.  This  simpleton  had  led  the  veterinary  diagnosti- 
cians a  merry  chase.  According  to  the  ofiicial  report  of  the 
first  cases  in  Wolfikon,  the  animals  had  died  of  an  undeter- 
mined epizootic,  probably  anthrax.  The  second  outbreak, 
in  Schwartzenbach,  was  diagnosed  as  "intestinal  diph- 
theria", especially  a  localization  of  malignant,  catarrhal 
fever  of  rectum  and  vagina.  In  both  places  elaborate  pre- 
cautions against  the  spread  of  the  malady  were  taken  by 
thorough  disinfection, 

Seco7id  Outbreak  in  Rickenbach 

In  the  same  stable  in  Rickenbach,  in  which  in  November, 
1895,  the  acts  described  above  were  committed,  an  ox  had  to 
be  destroyed  in  April,  1897,  because  of  rectal  hemorrhage. 
The  illness  lasted  four  days.  After  twelve  hours  there  were 
symptoms  of  colpitis.  After  four  days  there  escaped  from 
the  rectum  four  liters  of  blood.  The  animal  was  weak. 
Peritonitis  was  apparent.  Autopsy  revealed  bloody  infiltra- 
tion of  the  pelvic  organs,  kidneys,  and  adrenals.  The  veteri- 
narian found  numerous  injuries  in  the  rectal  mucosa,  five 
of  which  were  penetrant.  The  culprit  was  an  eighteen-year- 
old  caretaker  of  the  animal.  Apparently  he  was  not  as 
stupid  as  his  renowned  predecessor,  but,  according  to  his 
story,  the  master  had  related  the  misdeeds  of  the  other,  and 
seeing  in  the  stable  day  after  day  the  short  stick  previously 


Sodoviy  and  Sadism  237 

used,  finally  awakened  in  him  a  desire  for  the  same  experi- 
ence. 

The  Occurrence  in  Le  Menil-aux-Cerfs 

When  the  trauma  is  induced  by  less  violent  means  than 
those  already  described,  the  difficulties  of  diagnosis  increase. 
In  a  stable  of  about  ten  cows,  there  occurred,  within  three 
weeks  after  a  change  in  caretakers,  vaginitis  in  all  the  ani- 
mals. Ten  new  cows  added  later  soon  developed  the  vagini- 
tis. The  heifers,  when  they  reached  sexual  maturity,  also 
suffered.  With  the  advent  of  estrum  the  vaginitis  became 
worse,  and  at  the  same  time  the  disease  increased  in  in- 
tensity in  the  cows  near  the  one  in  estrum,  even  though  cas- 
trated. The  symptoms  began  with  swelling  of  the  perineum, 
then  a  discharge  of  clear,  tough  mucus,  which  later  became 
thick  and  purulent.  Once  colic  followed  estrum  for  several 
days.  The  general  health,  nutrition,  and  lactation  suffered 
little.  Pregnant  animals  generally  did  not  abort.  The  local 
handling  had  little  effect:  some  cows  conceived  again;  sev- 
eral remained  sterile  and  had  to  be  discarded.  The  owner 
was  compelled  to  sell  the  sterile  animals  for  less  than  the 
cost  of  new  ones.  He  was  tormented  with  the  fear  that  they 
had  been  inoculated  with  syphilis.  Investigations  were 
finally  made  by  Schwartz  of  Bern.  Four  cows  were  visibly 
diseased  ;  all  showed  colpitis,  and  two  of  them  severe  annular 
vaginal  stricture.  Five  other  cattle  offered  nothing  re- 
markable. The  cows  had  been  bred  to  two  public  bulls 
which  had  also  been  used  for  numerous  other  cows.  Neither 
the  cows  nor  the  bulls  suffered  from  any  visible  genital  dis- 
ease. The  conclusion  was  finally  reached  that  the  injuries 
were  due  to  rough  handling  by  some  evil-disposed  person 
but  it  appeared  very  difficult  to  so  much  as  suspect  the  cul- 
prit. Several  weeks  had  elapsed  when  by  accident  it  was 
discovered  that  the  caretaker  of  the  cows  was  the  culprit. 
Aside  from  this  the  man  was  a  model :  he  was  a  quiet,  punc- 
tual, thorough  worker,  and,  until  the  accidental  revelation, 
beyond  suspicion.    The  identification  of  the  culprit  revealed 


238  Diseases  of  the  Genital  Orgajis 

also  his  method.  It  consisted  of  pushing  a  fork  handle  into 
the  vagina  and  rapidly  turning  it  in  a  wide  circle.  This 
special  form  of  sadism  served  to  explain  the  strictures  of 
the  vaginae.  No  punishment  of  the  offender  was  under- 
taken, because  it  was  feared  it  would  lead  to  endless  trouble, 
and  the  model  servant  was  permitted  to  go  his  way  unmo- 
lested. 

I  have  found  no  account  of  this  type  of  injuries  in  this 
country.  They  probably  occur  and  escape  diagnosis.  In 
connection  with  public  institutions  for  mental  defectives  we 
have  many  valuable  dairy  herds  in  which  the  cattle  are 
largely  placed  in  charge  of  ''trusties".  Since  such  mental 
defectives  might  resort  to  such  practices,  veterinarians  hav- 
ing charge  of  such  herds  would  do  well  to  keep  this  possi- 
bility in  mind  and  not  be  led  too  far  afield  in  diagnosis. 


PART  II 

TUMORS  OF  THE  GENITAL  ORGANS 

The  fundamental  nature  of  tumors  is  essentially  undeter- 
mined. Clinically,  many  of  the  benign  tumors  of  animals 
bear  strong  evidences  of  transmissibility.  They  appear  un- 
expectedly in  a  stable  or  herd,  or  in  a  group  of  animals 
within  a  herd,  and  involve  simultaneously  a  large  percentage 
of  the  group.  At  present  the  general  concensus  of  scientific 
opinion  appears  to  be  that  malign  tumors  are  due  to  infec- 
tion. Certain  new-growths  formerly  regarded  as  true  tu- 
mors, like  actinomycosis  and  botryomycosis,  are  now  defi- 
nitely classed  as  infections.  In  the  dog,  there  occurs  a 
clearly  defined  venereal  tumor  definitely  ascribed  to  infec- 
tion, which  is  included  among  venereal  infections  instead  of 
among  tumors. 

Chapter  X 

A.    MALIGNANT  TUMORS 

1.    Malignant  Tumors  of  the  Male  Genitalia 

Herbivora,  and  especially  ruminants,  are  apparently 
highly  resistant  to  malignant  neoplasms.  This  may  be  ap- 
parent only  because  most  domestic  ruminants  are  slaugh- 
tered early  in  life  for  food.  More  than  fifty  per  cent,  of  all 
dairy  calves  born  are  slaughtered  for  veal.  More  than 
ninety  per  cent,  of  male  cattle  of  beef  breeds  are  castrated 
and  are  slaughtered  at  three  to  four  years  of  age.  The  aver- 
age age  of  dairy  cows  is  below  six  years,  though  occasionally 
they  live  to  fifteen,  eighteen  or  more. 

Malignant  neoplasms  affect  chiefly  adult  or  old  animals. 
Naturally  it  follows  that  they  would  be  rare  in  species  where 
the  technically  normal  duration  of  life  is  greatly  abbreviated 
by  artificial  means. 

Malignant  neoplasms  in  domestic  animals  are  most  fre- 
quent in  dogs  and  horses,  both  of  which  are  largely  kept 


240  Diseases  of  the  Genital  Organs 

until  old  age.  In  the  dog,  the  animal  which  suffers  most 
frequently  from  malignant  tumors,  the  normal  span  of  life 
is  but  ten  to  twelve  years,  the  briefest  among  domestic  ani- 
mals. 

Malignant  new-growths  may  invade  any  portion  of  the 
genital  system,  of  either  sex  and  in  all  species,  and  may 
vary  greatly  in  histologic  type. 

Malignant  tumors  of  the  genital  organs  of  bulls  (as  well 
as  of  rams  and  he-goats)  are  exceedingly  rare.  I  have  not 
observed  a  well  defined  clinical  case  and  have  no  clearly 
identified  specimen  in  my  collection.  Possibly  I  am  in  error. 
Young  bulls  very  frequently  have  angry-looking,  highly 
vascular  tumors  on  the  glans  penis  which,  examined  histo- 
logically, are  found  to  be  epithelial.  They  are  commonly 
described  as  carcinomata,  but  histologists  are  not  wholly 
agreed  upon  this  point.  So  far  as  I  have  observed  clinically, 
they  are  usually  not  malign,  however  suggestive  their  ap- 
pearance may  be.  When  carefully  excised,  they  show  little 
tendency  to  recur ;  when  neglected,  they  cause  no  daughter 
tumors  in  the  peri-penial  lymph  glands. 

The  diagnosis  and  handling  of  malign  tumors  of  the  geni- 
tal organs  of  bulls  (and  of  rams  and  he-goats)  must  be 
based  upon  general  principles.  When  involving  the  glans 
penis  in  a  valuable  bull,  liberal  amputation  may  be  applied, 
which,  if  timely,  may  eliminate  the  tumor  and  preserve  the 
procreative  powers  of  the  animal.  The  amputation  should  be 
made  under  the  technic  described  later  for  the  amputation 
of  the  penis  of  the  stallion. 

At  one  time  I  doubted  the  ability  of  a  bull  to  copulate 
readily  after  the  amputation  of  the  glans  penis.  I  attended 
one  famous  sire  which  had  suffered  from  a  tumor  on  the 
■glans.  Sections  of  the  tumor  had  been  examined  by  a 
pathologist  and  pronounced  carcinomatous.  The  glans  had 
been  amputated.  The  stump  refused  to  heal,  and  was  in- 
tensely inflamed  and  angry.  After  long  and  patient  hand- 
ling, the  stump  healed  and  the  bull  returned  successfully  to 
breeding. 


Malignant  Tumors  241 

When  amputating  the  penis  of  a  bull  (or  ram  or  boar)  it 
must  be  recalled  that  these  animals  are  always  affected  with 
the  granular  venereal  disease,  which  retards  healing  and 
aggravates  the  wound.  Prior  to  amputation  it  is  therefore 
advisable  to  disinfect  the  glans,  prepuce,  and  sheath  by 
douching  the  parts  daily  for  five  to  eight  days  with  a  0.25 
to  0.5  per  cent.  Lugol's  solution,  or  other  safe  antiseptic. 
After  the  penis  has  been  amputated,  it  is  desirable  to  con- 
tinue the  douching  until  the  healing  is  complete. 

The  bull  should  be  kept  apart  from  cows  in  estrum,  and 
otherwise  handled  in  a  manner  to  obviate  sexual  excitement, 
because  erection  inevitably  aggravates  any  penial  disease. 
It  is  bad  policy  generally  to  cause  the  bull  to  become  sexu- 
ally excited  in  order  to  have  him  protrude  the  penis  for 
visual  examination  in  case  of  disease.  It  is  better,  and  far 
more  satisfactory  from  every  standpoint,  to  cast  the  bull 
and  expose  the  penis  by  eliminating  the  S-curve,  as  de- 
scribed in  Chapter  II. 

If  the  ordinary  douching  of  the  sheath  and  prepuce  fails 
to  hold  in  check  the  infection  and  inflammation  in  the  stump, 
the  animal  should  be  cast,  the  penial  stump  exposed,  and 
the  inflamed  areas  pencilled  over  with  silver  nitrate  or 
dressed  with  a  strong  solution  of  the  same.  It  should  be 
remembered  that  the  conditions  are  inimical  to  prompt 
healing  and  that  it  is  far  better  to  hasten  the  healing  pro- 
cess to  the  maximum  by  giving  concentrated  attention  at 
the  beginning,  thus  obviating  the  necessity  for  prolonged 
handling  which  will  in  the  end  greatly  exceed  the  total  care 
required  if  minute  details  are  faithfully  followed  at  first. 

Hendryckx^  states  that  in  the  course  of  malignant  disease 
of  the  testicle  the  organ  may  undergo  necrosis  and  open 
upon  the  exterior  of  the  scrotum  and  the  new-growth  as- 
sume the  clinical  characters  of  external  cancer. 

When  malignant  neoplasm  of  the  testicle  is  diagnosed  or 
seriously  feared,  the  gland  should  promptly  be  removed.    A 

'  Bayer  and  Frohner.   Handbuch  der  tierarztlicbe  Chirurgie  und  Geburts- 
hilfe,  Vol.  Ill,  Part  2,  Page  439,  1899. 
16 


242  Diseases  of  the  Geyiital  Organs 

positive  diagnosis  of  malignancy,  with  all  the  risks  of  ex- 
tension and  of  daughter  tumors,  should  not  be  awaited. 
Any  chronic  tumefaction  of  the  testicle  sufficient  to  arouse 
fear  of  malignancy  should  be  treated  decisively  and 
promptly  as  malignant.  In  any  case,  the  function  of  the 
testicle  is  almost  certainly  destroyed  and  the  ablation  of  the 
hopelessly  diseased  gland  is  the  prudent  course  to  pursue. 
The  removal  of  one  testicle  neither  destroys  nor  curtails 
the  reproductive  power  of  the  animal. 

The  removal  of  a  testicle  which  is  presumably  affected 
with  a  malignant  new-growth  should  preferably  be  effected 
by  the  covered  operation.  The  skin  and  dartos  are  freely 
incised  down  to  the  cremaster  muscle  or  its  fascia.  The 
cremaster,  its  fascia,  'and  the  peritoneal  layer  of  the  scro- 
tum are  kept  intact  and  a  separation  made  between  the  cre- 
master and  dartos  up  to  the  external  inguinal  ring.  The 
spermatic  cord,  covered  by  the  cremaster  muscle  and  the 
scrotal  peritoneum,  is  then  securely  ligated  at  a  point  as  high 
as  is  convenient  or  required.  It  is  best  to  arm  a  heavy  needle 
with  a  strong  thread  and  pass  it  through  the  cremaster 
muscle,  scrotal  peritoneum,  and  spermatic  cord.  The  needle 
is  removed  and  the  ligature  tied  about  the  spermatic  cord 
and  cremaster  very  tightly,  in  order  to  make  inevitable  the 
immediate  necrosis  of  all  included  tissues.  The  included 
mass  is  then  excised  on  the  distal  side  of  the  ligature  at  a 
distance  sufficient  to  guard  securely  against  its  slipping, 
generally  about  one  inch.  The  cavity  in  the  scrotum  should 
then  be  tamponned  with  antiseptic  gauze  and  the  cutaneous 
wound  closed  by  sutures.  The  gauze  should  be  allowed  to 
protrude  at  the  lowest  part  of  the  wound,  in  order  to  permit 
drainage. 

Malignant  tumors  of  other  portions  of  the  genital  tract 
of  the  bull  are  not  as  amenable  to  handling  as  are  those  of 
the  glans  penis  and  the  testicle.  They  need  to  be  handled 
according  to  general  principles. 

Malignant  tumors  of  the  genital  organs  of  horses  are  not 
at  all  rare.     According  to  my  observation,  they  are  com- 


Malignant   Tumors  243 

moner  in  geldings  than  in  stallions.  This  relates  especially 
to  the  penis.  Clinically,  also,  I  have  seen  more  malignant 
neoplasms  in  the  stumps  of  the  spermatic  cords  of  geldings 
than  in  the  testicles  of  stallions.  It  is  possible  that  the  es- 
sentially dormant  genitalia  of  emasculated  animals  are  more 
vulnerable  to  malignant  new-growths. 

The  testicle  and  epididymis  of  the  stallion  is  only  very 
rarely  the  seat  of  malignant  tumors.  In  one  stallion  I  diag- 
nosed clinically  malignant  disease  of  the  testicle,  but  had 
no  opportunity  to  verify  my  diagnosis  by  direct  examina- 
tion of  the  gland.  In  the  college  collection  there  are  no 
specimens  of  malignant  disease  of  the  testicles  of  the  horse. 
When  cryptorchidy  occurs  in  man,  it  commonly  raises  the 
question  of  malignant  disease  of  the  testicle.  Although 
cryptorchidy  is  very  common  in  horses,  the  condition  is 
rarely,  if  ever,  attributable  to  malignant  disease.  The  clini- 
cal diagnosis  of  malignant  disease  of  the  testicles  is  to  be 
made  upon  the  same  general  basis  as  the  diagnosis  of  malig- 
nant tumors  of  other  organs. 

When  malignant  disease  of  the  testicle  in  the  horse  is  se- 
riously feared,  the  gland  should  be  promptly  removed  for 
the  same  reasons  and  in  the  same  manner  as  already  de- 
scribed for  the  bull. 

Malignant  disease  of  the  testicles  and  epididymis  in  other 
domestic  animals  is  rarely  reported.  Clinically  I  removed 
successfully  a  cryptorchid,  cancerous  testicle  from  a  pig. 
It  was  adherent  over  its  entire  surface  to  the  adjacent  in- 
testines and  mesentery,  so  that  it  had  to  be  dissected  away 
carefully. 

Malignant  disease  of  the  penis,  sheath,  and  prepuce  in  the 
stallion  is  generally  supposed  to  be  common.  At  least, 
writers  upon  veterinary  surgery,  as  Cadiot\  Bayer  and 
Frohner'-,  and  others,  would  lead  the  reader  to  believe  so. 
I  have  not  observed  a  case  in  either  penis,  prepuce,  or 
sheath  in  a  stallion,  and  my  collection  contains  no  specimen. 

1  Traits  de  Therap.  Chir.  d.  Animaux  Domestiques,  1S98,  p.  674. 

2  Handbuch  d.  Tier.  Chir.  u.  Geburtsh.,  1S99,  vol.  iii.  Part  II,  p.  345. 


244  Diseases  of  the  Genital  Organs 

On  the  other  hand,  the  occurrence  in  geldings  has  been  rela- 
tively common.  This  may  be  apparent  only.  Since  in 
America  essentially  all  colts  not  desired  for  breeding  pur- 
poses are  castrated,  the  ratio  of  stallions  to  geldings  is  less 
than  five  per  cent.  Consequently  one  would  logically  expect 
to  see  at  least  twenty  to  twenty-five  malignant  new-growths 
in  geldings  to  one  in  stallions.  The  malignant  tumors  of 
these  parts  may  be  sarcomatous  but  are  most  frequently 
carcinomatous.  Their  character  is  generally  diagnosable 
by  clinical  examination.  Usually  there  is  abundant  necro- 
sis of  the  diseased  parts  and  rapid  growth  and  in  all  re- 
spects they  show  typical  malignancy.  As  in  malignant  dis- 
ease generally,  there  is  rarely  any  early  trace  of  cancer 
cachexy.  The  general  health  of  the  animal  remains  as  a 
rule  unimpaired  for  several  months,  unless  the  disease  in- 
terferes with  some  vital  function  either  by  mechanical  im- 
pediment or  by  invading  a  vital  organ  (liver,  lungs).  Ma- 
lignant disease  of  the  penis,  sheath,  and  prepuce  ordinarily 
proves  fatal  indirectly,  through  daughter  tumors  in  a  vital 
organ.  Thus,  in  one  case  in  my  clinic,  carcinoma  of  the 
sheath  caused  death  through  the  breaking  down  of  a  daugh- 
ter tumor  in  the  lungs. 

The  clinician  should  not  err  in  diagnosing  benign  tumors 
of  the  penis  as  malign.  The  ordinary  benign  epithelioma 
of  the  equine  penis  is  highly  vascular  and  undergoes  pres- 
sure and  attrition  necrosis.  The  necrotic  tissues  and  the 
sebum  produce  much  highly  fetid  pus  containing  tissue  de- 
bris, and  often  blood.  That  should  not  be  accepted  as  evi- 
dence of  malignancy.  The  necrosis  of  malignant  neoplasms 
is  fundamental  and  inherent,  and  not  attributable  to  pres- 
sure or  attrition.  When  essential,  the  diagnosis  may  be 
safeguarded  by  the  removal  of  a  portion  of  the  tissue  for 
pathologic  study. 

The  veterinarian  should  also  be  on  the  alert  in  diagnosis 
not  to  mistake  bursattee  of  the  penis  and  prepuce  for  ma- 
lignant neoplasms.  The  necrosis  of  bursattee  is  funda- 
mental, like  cancer,  but  its  other  characters  serve  to  differ- 


.  -i  mp  u  fa  tio  n  of  th  e  Pen  is  245 

entiate  it.  This  will  be  discussed  while  dealing  with  the  in- 
fections of  the  genitalia  of  horses. 

The  handling  of  malignant  disease  of  prepuce,  sheath, 
and  penis  of  the  breeding  stallion  calls  for  prompt  and 
skillful  measures.  The  early  ablation  of  the  neoplasm  is 
the  only  course  known  which  offers  hope  .  Even  then  the 
hope  is  based  upon  the  complete  extirpation  of  the  growth, 
in  such  a  manner  as  not  to  interfere  with  the  power  to  copu- 
late. When  involving  the  sheath  only,  complete  removal 
may  be  possible,  but  there  is  danger  of  such  deformation 
of  the  parts  as  will  cause  faulty  direction  of  the  erected 
penis.  If  the  prepuce  is  involved,  a  greater  danger  faces 
the  surgeon  because  adhesions  between  the  direct  and  re- 
curved portions  may  bar  the  protrusion  of  the  penis. 

When  the  penis  itself  is  involved,  the  amputation  of  a 
part  or  all  of  the  glans  does  not  disable  the  animal,  but  if 
the  amputation  needs  to  be  on  the  proximal  side  of  the  pre- 
putial ring,  the  breeding  capacity  of  the  animal  is  probably 
ruined.  I  find  no  conclusive  data  on  this  point,  but  it  has 
been  proven  clinically  that  the  glans  can  be  amputated  with- 
out serious  interference.  In  the  present  state  of  our  knowl- 
edge, when  the  malignant  growth  has  extended  beyond  the 
glans  into  the  penial  body,  no  hope  should  be  given  of  re- 
storing the  breeding  powers.  In  a  gelding  I  have  seen  the 
cancerous  growth  involving  the  entire  penis  from  the  glans 
to  the  attachments  of  the  crura  to  the  ischial  tuberosities. 

2.    Amputation  of  the  Penis 

Almost,  if  not  all  cases  of  malignant  tumors  of  the  glans 
penis  should  be  handled  by  the  amputation  of  a  portion  or 
all  of  the  glans.  The  amputation  should  be  carried  out  by 
the  following  technic,  which  affords  ample  security  against 
urethral  stricture  and  provides  a  tapering  stump  which  can 
most  readily  enter  the  vulva  in  copulation.  The  amputation 
of  the  penis  of  the  stallion  affords  a  technic  equally  applica- 
ble to  that  of  other  species. 


246 


Diseases  of  the  Genital  Organs 


Instruments.  Scalpel,  elastic  ligature,  strong  silk  suture, 
strong  piece  of  tape  1  m,  long,  artery  and  compression  for- 
ceps. 

Technic.    The  operation  is  carried  out  on  the  recumbent 


Vie.  62 — Amputation  of  Penis. 
First  staj^e  of  opL-ration.      T,  Elastic  li}.,'ature  used  as  ti)uriii([uet  ;   CS,  cor- 
pus spongiosum  of  uratlira  ;  -S",  skin  ;   CC,  corpus  caveruosum  ; 
U,  urethra  ;  A,  ligature  ;  C,  catheter. 

animal,  under  local  or  general  anaesthesia.  The  upper  hind 
foot  is  drawn  backward  or  upward  or  otherwise  so  fixed  as 
not  to  obstruct  the  field  of  operation.  The  point  of  opera- 
tion is  determined  bv  the  character  of  the  disease  and  the 


Ampiitatio7i  oj  the  PeJiis 


247 


object  to  be  attained.  It  may  be  made  at  any  point  from 
the  glans  penis  to  the  attachment  of  the  corpus  cavernosum 
to  the  ischium,  but  if  possible  in  front  of  the  preputial  ring. 
After  the  penis  has  been  drawn  out,  and  the  preputial  re- 
gion carefully  cleansed  and  disinfected,  an  assistant  grasps 
the  organ  just  behind  the  preputial  ring  and  holds  it  firmly. 
A  catheter  is  then  introduced  into  the  urethra  and  pushed 
upward  beyond  the  point  where  it  is  designed  to  amputate 


FIG.  63 — Amputation  of  the  penis  showing  needle  inserted 

for  a  suture. 

F,  Dorsal  vessels  of  penis  ;  A,  fibrous  tunic  of  the  corpus  cavernosum  ; 

S,  skin  ;  CC,  corpus  cavernosum  ;  CS,  corpus  spongiosum 

of  urethra  ;    U,  urethra. 


the  organ.  A  temporary  elastic  ligature,  T,  is  then  applied 
above  the  assistant's  hand  around  the  penis,  or  a  piece  of 
tape  is  looped  around  it  above  the  hand  and  is  made  to  serve 
both  as  a  tourniquet  and  as  a  means  for  holding  the  penis, 
or  the  penis  may  be  grasped  in  front  of  the  ligature  with 
double  tenaculum  forceps  and  held. 


248 


Diseases  of  the  Genital  Organs 


A  small  cord  is  applied  just  behind  the  glans  penis,  L,  Fig. 
62,  and  a  triangular  incision  is  made  on  the  ventral  surface 
of  the  organ  about  4  cm.  long  by  3  cm,  wide,  the  base  of  the 
triangle  being  forward  as  shown  in  the  figure ;  this  incision 
is  carried  through  the  skin,  S,  the  corpus  spongiosum,  CS, 
and  along  the  corpus  cavernosum,  CC,  down  to  the  urethra, 


Xh 


Fic.  64 — Amputation  of  the  Penis. 
Completed  operation  showing  sutures.    i\  Urethra.    T,  Elastic  Lij^ature. 

U.  In  the  triangular  area  the  tissues  are  dissected  away 
without  opening  or  wounding  the  urethra  and  then  a  longi- 
tudinal incision  is  made  from  near  the  apex  of  the  triangle 
to  its  base  through  the  urethral  walls  to  the  catheter.  Be- 
ginning at  the  apex  of  the  triangular  wound,  a  series  of  in- 
terrupted sutures  is  inserted,  as  shown  in  Fig.  64,  in  such  a 
manner  that  they  pass  through  the  urethral  wall  and  the 
skin,  so  that  when  tied  the  wounded  surfaces  are  completely 


Amputation  of  the  Penis  249 

hidden  and  the  urethral  mucous  membrane  is  brought  into 
apposition  with  the  integument.  These  sutures  are  contin- 
ued down  to  the  base  of  the  triangle,  the  catheter  is  removed 
and  the  organ  is  excised  by  a  cut  extending  in  a  slightly 
oblique  direction  from  below  upward  and  forward.  A 
straight  needle  armed  with  a  silk  suture  is  passed  through 
the  margin  of  the  urethral  wound,  the  adjacent  fibrous  cap- 
sule of  the  corpus  cavernosum,  and  across  but  not  through 
the  erectile  tissue,  inserted  again  into  the  superior  portion 
of  the  fibrous  capsule  and  carried  out  through  the  adjacent 
dorsal  vessels  and  the  skin,  as  shown  in  Fig.  63,  and,  bring- 
ing the  ends  of  the  sutures  together,  tied  in  such  a  way  that 
the  urethral  mucous  membrane  and  the  margin  of  the  skin 
are  brought  into  immediate  contact  and  the  blood  vessels  se- 
curely closed  in  such  a  manner  as  to  guard  against  hemor- 
rhage. By  this  plan  when  the  sutures  are  tied,  the  cut  bor- 
ders of  the  fibrous  envelope  are  brought  together  over  the 
erectile  tissue,  thus  preventing  hemorrhage  from  that  tissue 
also.  As  many  sutures  are  inserted  as  may  be  required  to 
close  the  wound  securely  and  finally  leave  every  part  wholly 
covered  with  epithelium.  By  this  plan  stricture  of  the  ure- 
thra in  the  process  of  healing  is  avoided.  The  tourniquet  is 
removed  and  the  patient  released. 

The  principles  here  laid  down  are  applicable  and  advisa- 
ble in  the  amputation  of  the  penis  in  all  domestic  animals. 
In  the  dog,  the  point  of  amputation  should  be  above  the 
penial  bone. 

Once  the  amputation  has  been  successfully  completed,  the 
healing  of  the  stump  should  be  favored  by  keeping  the  parts 
scrupulously  clean  with  frequent  douchings.  The  patient 
is  much  better  if  given  abundant  exercise,  avoiding  con- 
stantly, as  far  as  may  be  practicable,  any  sexual  excitation 
because  erection  strains  the  sutures,  engorges  the  wound 
area,  and  seriously  impedes  the  healing  process.  The  diet 
should  be  scant  and  laxative. 


250 


Diseases  of  the  Getnlal  Organs 


3.    Malignant  New-Growths  of  the  Female  Genitalia 

Malignant  tumors  of  the  female  genital  organs,  generally 
very  rare,  are  most  often  seen  in  the  vulva  and  ovary.  I 
have  observed  but  one  case  of  malignant  tumor  of  the 
uterus — that  one  case  in  the  bitch  (see  Fig.  65).  The 
malignant  growth  involved  the  entire  genital  tube,  but 
was  apparently  most  advanced  in  the  uterus.  The  symp- 
toms consisted  of  a  profuse,  fetid,  purulent  discharge  from 
the  vulva,  with  swelling  and  obstruction  of  the  lumen  of  the 
genital  passage.    When  discovered,  it  was  inoperable. 


Vie.  65— Sarcoma  of  Genital  Tract.     Bitch. 

/,  Rectiun  ;  ),  k-fl  ovidiu-l  ;    ,',  ovarv  ;    /,  iilcrus  ;  5,  v:i<,nii;i 

6,  urinary  hhulder. 


I  have  seen  two  clinical  cases  of  ovarian  carcinoma 
of  the  cow.  The  first  (see  Fig.  67)  was  in  a  pedigreed 
Holstein  heifer  which  had  proven  sterile.  Upon  rectal  pal- 
pation the  right  ovary  was  found  to  be  enormously  enlarged, 


Malignant  Neiv-Gro%vths or  the  Female  Genitalia 


251 


Fig.  67— Angio-Sarcom  of  Ovary,  Heifer. 

/,  Left  cornu  ;  2,  enlarged  right  ovarian  artery  ;  j,  tumor.  Below,  section 
of  tumor. 


252 


Diseases  of  the  Genital  Organs 


about  four  inches  in  diameter.  The  right  uterine  artery, 
enlarged  to  many  times  its  size,  as  indicated  in  Fig.  67, 
pulsated  with  great  force.  The  left  ovary  was  minute  and 
non-functional.  Slaughter  was  advised,  since  the  examina- 
tion indicated  clearly  that  surgical  interference  would  be 
highly  perilous  because  of  the  enormously  enlarged  ovarian 
artery.  The  removal  of  the  ovary,  also,  would  leave  the  left 
gland,  which  would  probably  not  function.  The  clinical 
diagnosis  was  angioma.  Upon  slaughter  it  was  found  that 
the  ovary  had  ruptured  at  one  point,  causing  profuse  hemor- 


FiG.  69— Cyst-Adenoma  of  Ovary.     Sow.     Weight  of  tumor  38  lbs. 

/,  Necrotic  area  ;  2,  2,  cvslic   areas. 


rhage.  The  entire  peritoneal  surface  was  thickly  studded 
over  with  tufts  of  yellowish  new-growth.  Histologically, 
the  tumor  proved  to  be  a  carcinoma,  or  rather  angiocar- 
cinoma. 


Benign  Tumors  of  the  Genital  Organs  253 

My  second  clinical  case  was  in  an  aged  Guernsey  cow. 
The  ovary  was  about  five  or  six  inches  in  diameter,  spheri- 
cal, tense,  and  smooth.  It  was  diagnosed  as  a  thick-walled 
cyst  of  the  non-nymphomaniac  type.  It  was  considered  both 
impossible  and  imprudent  to  rupture  the  cyst.  Ovariotomy 
was  performed  through  a  flank  incision.  Histologic  exami- 
nation showed  the  tumor  to  be  a  carcinoma. 

I  have  not  observed  clinically  in  other  animals  than  the 
cow  an  instance  of  malignant  disease  in  the  ovaries,  and 
have  but  one  specimen  of  malign  tumor  of  the  ovary  other 
than  those  mentioned  above.  This  is  a  multilocular  ovarian 
tumor  from  a  sow,  shown  in  Fig.  69.  The  sow  weighed 
about  three  hundred  pounds,  and  the  ovary  thirty-eight. 
Clinically  it  would  have  been  difficult  or  impossible  to  diag- 
nose. Inevitably  the  abdomen  of  the  sow  was  greatly  en- 
larged, but  that  might  have  been  from  hydronephrosis  or 
many  other  conditions.  In  this  fat  sow,  the  discovery  was 
made  after  slaughter. 

Carcinoma  of  the  vulva  is  not  at  all  rare  in  the  cow.  It 
presents  highly  distinctive  clinical  characters  which  render 
a  reliable  diagnosis  comparatively  easy.  When  reported  to 
the  veterinarian,  it  is  not  ordinarily  subject  to  surgical  in- 
terference. 

As  a  rule,  when  the  genital  organs  of  a  meat  animal  are 
invaded  by  malignant  new-growths,  if  they  are  still  local- 
ized, the  general  condition  good,  and  the  subject  not  of  great 
breeding  value,  the  animal  should  be  sent  to  slaughter. 

B.    Benign  Tumors  of  the  Genital  Organs 

1.    Benign  Tumors  of  the  Male  Genitalia 

Benign  tumors  are  very  common  upon  the  penis,  sheath, 
and  prepuce  of  horses  and  cattle.  These  two  species  are 
very  prone  to  growths  of  benign  epithelial  tumors,  or 
"warts",  about  the  face  and  lips  and  upon  the  external  geni- 
tal organs.  They  are  observed  almost  entirely  in  young 
animals.  Generally  they  are  papillomatous  in  type  and  tend 
to  become  polypoid  or  pedunculated.    This  is  especially  true 


254  Diseases  of  the  Genital  Organs 

when  they  are  located  upon  the  glans  penis  or  within  the 
sheath,  where  constant  compression  acts  to  modify  their 
form.  The  attrition  caused  by  protruding  and  retracting 
the  penis  tends  to  abrade  the  epithelium  covering  the  tumor. 
The  mucus,  sebum,  and  sometimes  urine,  tend  to  macerate 
and  irritate  the  new-growth.  As  a  consequence  of  these 
conditions,  ulceration,  superficial  necrosis,  and  suppuration, 
with  highly  repulsive  odor,  are  frequent  and  not  rarely  lead 
to  error  in  diagnosis. 

It  is  only  rarely  that  this  type  of  tumor  attains  such  size 
as  to  cause  phimosis  or  paraphimosis.  Possibly  one  reason 
for  this  is  that,  with  the  small  peduncle,  when  the  tumor  be- 
comes sufficiently  large  to  retard  the  movements  of  the 
penis,  the  stalk  divides  and  the  tumor  drops  away.  I  have 
had  them  drop  off  in  my  hand  when  attempting  to  make  a 
physical  examination.  They  are  readily  observed  during 
copulation.  The  copulatory  attrition  and  great  vascularity 
of  erection  commonly  cause  hemorrhage.  Such  tumors  call 
for  early  excision.  Benign  penial  tumors,  if  not  promptly 
removed,  may  extend  and  eventually  call  for  amputation  of 
the  penis,  though,  had  opportune  attention  been  given,  mere 
excision  of  the  tumor  would  have  sufficed. 

The  animal  should  be  cast  for  the  operation,  with  all  four 
limbs  extended,  or  may  be  secured  upon  the  operating  table. 
The  penis,  whether  of  stallion,  bull,  or  other  male,  should  be 
exposed  and  secured  as  advised  in  Chapter  II,  and  either 
general  or  local  anaesthesia  applied,  as  conditions  may  dic- 
tate. When  the  peduncle  is  small  and  superficially  attached, 
it  should  be  excised,  removing  a  liberal  amount  of  normal 
tissue  with  it  in  order  to  have  assurance  that  all  the  neo- 
plasm is  included.  Care  should  be  taken  not  to  remove  an 
unnecessarily  large  amount  of  tissue,  because  the  contrac- 
tion of  the  cicatrix  is  liable  to  bend  the  penis  at  an  angle 
and  make  copulation  difficult  or  impossible.  The  invasion 
of  the  penial  tissue  had  best  not  be  circular  nor  transverse, 
but  preferably  the  base  of  the  peduncle  should  be  removed 
by  making  two  incisions  beginning  above  or  on  the  proximal 


Benign    Tnmors  of  the  Genital  Orgaris 


255 


side  of  the  base  of  the  peduncle,  diverging  sufficiently  to 
pass  on  either  side  of  it,  and  then  converging  to  meet  at  an 
equal  distance  on  the  distal  side  of  the  base,  making  a 
wedge-shaped  incision  extending  into  the  penial  tissues,  so 
that  the  wound  may  be  closed  with  chromatized  catgut.  In 
this  manner  deformation  of  the  penis  will  be  avoided  as  far 
as  practicable.  A  careless  transverse  incision  is  more  liable 
to  invade  an  important  nerve  or  arterial  trunk  and  inter- 


FiG.  70— Dermoid  Cyst.     Cryptorchid  Stallion. 

/,  Glandular  tissue  ;  2,  osseous  tissue  ;   j,  cavity  in  the  bony  structure  ; 
^,  epididymis  ;  5,  spermatic  cord. 

fere  with  the  erection  of  the  tissues  supplied  by  the  vessel. 
If,  in  spite  of  such  precautions,  deformation  occurs  which 
prevents  copulation,  or  if  the  base  of  the  tumor  is  too  ex- 
tensive to  permit  excision  without  serious  deformation,  re- 
course must  be  had  to  amputation,  as  already  described. 

Many  other  types  of  benign  tumors  involve  the  male  geni- 
tal organs,  but  they  occur  very  rarely  and  offer  nothing  of 
special  importance  in  handling  with  reference  to  breeding. 


Diseases  oj  the  Genital  Organs 


-Dermoid  Cyst  of  Ovary.     Mare. 

.„ t  l,„;.,,,   e,\\a.A    i.-UTi   lr>ncr     iiiattp 


Fig.   70a— Dermoid  Cyst  of  Ovary.     Mare. 

/,  Cystic  ovarv,  the  cyst  being  filled  with  loug.  matted  hairs 

C,  carti'lage  ;  2,  normal  ovary  from  same  animal. 


Fig.  job— Cystic  Ovary  of  Mare.     Divided. 

The  cyst  was  about  8   inches   in  diameter  with  very  thick,  resistant  walls 

/,  lixterior  of  cvst,  showing  at  P,  the  pavilion  of  the  oviduct  llattened 

against  the  cyst  ;  .^  the  interior  of  the  cyst,  showing  the  thick  walls. 


Benign  Tumors  of  the  Female  Genilalia  257 

Dermoid  cysts  of  the  testicle  occur  now  and  then,  contain- 
ing bones,  teeth,  hair,  or  all  three  (see  Fig.  70).  Such  tes- 
ticles occur  almost  wholly  in  the  horse,  are  generally  crypt- 
orchid,  and  are  beyond  remedy  as  to  breeding,  but  should 
be  removed  in  order  to  eliminate  the  sex  desire,  frequently 
perverted,  which  they  cause.  If  the  other  testicle  is  sound, 
the  animal  is  fertile.  No  data  exist  to  indicate  that  such  an 
aberration  in  development  does  or  does  not  tend  to  recur  in 
the  progeny  of  such  a  male,  but,  since  arrests  in  develop- 
ment generally  tend  to  be  transmitted  to  the  offspring,  it  is 
well  to  be  on  guard  and  view  with  distrust  the  use,  as  a  sire, 
of  an  animal  so  affected.  Cysts  of  the  testicle,  epididymis, 
and  spermatic  cord  are  recorded. 

2.    Benign  Tumors  of  the  Female  Genitalia 

Benign  tumors  of  the  ovaries  proper  are  exceedingly 
rare.  I  have  no  well-marked  example  in  my  collection,  al- 
though they  are  recorded  in  great  variety.  Since,  when 
they  involve  one  ovary  only,  fertility  is  unimpaired,  they 
are  not  sought  in  connection  with  sterility.  They  are  but 
rarely  of  such  volume  as  to  change  the  appearance  of  the 
animal.  Most  frequently  they  attract  clinical  attention  by 
causing  incarceration  colic,  the  tumor  having  fallen  over  an 
intestine  so  that  its  long  peduncle  becomes  wrapped  about  it 
in  a  manner  to  prevent  the  free  passage  of  feces  along  the 
canal.  Generally  the  bodies  leading  to  such  incarceration 
colic  are  not  true  tumors.  Most  frequently  they  are  ovarian 
(Fig  71)  or  par-ovarian  (Figs.  72-74)  cysts  of  large  size. 
There  are  at  least  four  distinct  types  of  ovarian  cysts  in 
cows,  and  probably  an  equal  number  in  other  species : 

1.  There  are  generally  present  a  large  number  of  small 
cysts,  from  1/20  to  1/10  of  an  inch,  apparently  atretic  folli- 
cles. They  have  no  known  relation  to  breeding  efficiency  or 
to  the  general  well-being  of  the  animal. 

2.  The  moderate-sized  cysts  of  nymphomania,  apparently 
resulting  from  the  death  of  the  ovum,  as  a  result  of  ovarian 
infection  associated  with  an  increased  volume  of  follicular 
fluid. 


258 


Diseases  of  the  Genital  Orga7is 


\ 


\ 


i.'.r-    7.     I.are-e  ovarian  cyst  of  preg-nant  cow  {■^ho^■v^  with  pair  of 
''"  J'^l\\fries  (l.;.low)%howing  corpus  luteum  of  pregnancy. 


Benign  Tiunors  of  the  Female  Genitalia 


259 


3.  Cystic  degeneration  of  the  corpus  luteum. 

4.  Large,  single,  thick-walled  cysts  which  may  reach  an 
indefinite  volume  and  are  of  unknown  origin. 

The  fourth  type  described  commonly  bars  functional  ac- 
tivity in  the  involved  organ,  but  does  not  interfere  with  the 
reproductive  powers  of  the  other  gland.  The  chief  interest 
in  such  cysts  is  their  volume  and  their  power,  in  common 
with  par-ovarian  cysts,  to  cause  incarceration  of  the  intes- 


FiG.  72— Parovarian  Tumor  of  Mare,  Incarcerating  Rectum. 

View  from  right  side  with  the  tumor,    T,  almost  hidden  by  the 

constriction  caused  by  the  pedicle. 

Lettering  same  as  Fig.  74 

tines.  The  diagnosis  of  large  ovarian  or  par-ovarian  cysts 
must,  as  a  rule,  be  tentative  only.  One  large  and  somewhat 
cystic,  malignant,  ovarian  neoplasm  in  a  cow  was  diagnosed 
by  a  colleague  as  an  "abscess  in  the  uterine  ligament".  I 
diagnosed  it  as  a  large  ovarian  cyst.  This  also  was  erro- 
neous. It  was  indeed  somewhat  cystic,  but  the  error  would 
have  been  very  important  had  an  attempt  been  made  to  rup- 
ture or  puncture  the  malignant  growth  within  the  peritoneal 


26o 


Diseases  of  the  Genital  Organs 


cavity.  Therefore  it  is  best  to  use  caution  in  diagnosis, 
when  the  ovary  is  extremely  large.  However  confident  one 
may  feel  that  he  is  dealing  with  a  benign  cyst,  he  should  re- 
member that  it  may  be  malignant  and  in  operating  proceed 
upon  a  safe  course  by  performing  laparotomy  and,  if  pos- 
sible, removing  the  gland  intact. 


M 


l"'iG  73 — View  of  Fi,y[.  72  from  left  side,  the  tumor  exposeil  by 

cuttinjf  away  part  of  mesentery. 

Lettering  same  as  V\\i,.  7.4 


In  mares  and  cows  the  diagnosis  of  uncomplicated  cases 
is  to  be  made  by  rectal  palpation,  with  the  uterus  and  ova- 
ries drawn  back  as  far  as  prudent  by  fixing  uterine  forceps 
upon  the  cervix  and  exerting  traction.  If  the  cyst  is  very 
large,  the  ovarian  ligament  and  the  oviduct  may  be  much 
elongated,  so  that  the  ovary  may  lie  far  ahead  of  its  normal 


Benign  Tumors  of  the  Female  Genitalia 


261 


location,  anterior  to  the  apex  of  the  uterine  cornu  When 
large  ovarian  tumors  cause  incarceration  colic,  the  diagno- 
sis is  not  always  easy.  If  the  incarceration  involves  the  pel- 
vic portion  of  the  rectum,  the  veterinarian  faces  a  rather 
delicate  problem  in  diagnosis.  He  can  not  palpate  the  uterus 
and  ovaries  T^e?"  vaginam,  and  he  may  find  palpation  per 
rectum  barred  by  incarceration.  The  principal  question 
lies  between  a  stricture  of  the  rectum  and  a  mechanical  con- 
striction investing  the  gut  from  within  the  pelvic  cavity. 
The  investment  of  the  rectum  by  means  of  the  peduncle  of 


Fig.  74— Schematic  illustration  of  method  of  incarceration. 

/,   Intestine  ;  M,  mesentery  ;   O,  ovary  ;    T,  parovarian  tumor  or  cyst  ; 

P,  pedicle  of  tumor  ;  J^,  rectum  ;  7^',  rectum  posterior 

to  point  of  strangulation. 

an  ovarian  or  other  tumor  produces  no  changes  in  the  walls 
of  the  rectum  such  as  those  encountered  in  actual  stricture. 
There  is  no  inflammation,  no  sclerosis,  and  no  edema  of  the 
rectal  walls,  if  they  have  not  been  neglected  nor  tampered 
with.  The  hand  may  pass  freely  along  the  rectum  until  it 
comes  suddenly  upon  the  constricted  portion,  when  further 
progress  is  more  or  less  completely  barred.  In  the  incarcera- 
tion colic  caused  by  the  parovarian  cyst  illustrated  in  Figs. 
72,  73  and  74,  the  clinical  features  were  identical  with  those 
due  to  ovarian  incarceration  of  the  intestine.  I  found  that 
anteriorly  a  finger  could  be  passed  through  the  constriction 
into  the  free  portion.  The  constriction  was  necessarily  lim- 
ited in  area  to  the  diameter  of  the  peduncle  of  the  cyst.    The 


262  Diseases  of  the  Genital  Organs 

distinguishing  element  in  the  case  should  have  been  (my 
colleagues  and  I  each  failed  in  diagnosis)  that  the  constric- 
tion was  not  in  the  rectal  wall  but  was  due  to  an  investing 
cord  outside  the  intestine.  The  history  aids  in  diagnosis. 
True  stricture  usually  develops  gradually,  and  commonly 
has  a  history  of  prior  injury.  Perirectal  abscesses  or  tu- 
mors develop  slowly,  and  the  symptoms  of  colic  come  on 
gradually.  Ovarian  and  parovarian  pedunculated  tumors 
cause  no  clinical  manifestations  until  some  accidental  dis- 
placement of  the  tumor  causes  a  sudden  incarceration  of  the 
intestine  by  the  tumor  peduncle  and  violent  colic  quickly 
ensues. 

In  the  diagnosis  of  this  type  of  intestinal  incarceration, 
it  is  not  essential  that  the  histologic  character  be  deter- 
mined. It  is  of  little  surgical  consequence,  for  the  moment, 
whether  the  tumor  be  ovarian  or  par-ovarian,  cystic  or 
solid.    It  calls  for  prompt  relief  by  surgical  means. 

These  tumors  attain  a  diameter  of  four  to  twelve  or  more 
inches.  Owing  to  their  weight  they  drop  forward  and 
downward  in  the  abdomen  and  their  attachments  become 
greatly  elongated.  They  consist  of  a  single  cyst,  generally 
showing  traces  of  ovarian  tissue,  flattened  out  on  one  side 
of  the  spherical  cyst.  I  have  seen  one  in  a  mare  presented 
in  my  clinic  because  of  recurrent  severe  colics.  Rectal  ex- 
amination revealed  an  ovarian  tumor,  regular  in  outline, 
about  ten  inches  in  diameter.  Its  cystic  character  was  as- 
sumed, but  could  not  be  definitely  ascertained.  The  ovary 
(left)  was  successfully  removed  through  an  incision  in  the 
left  flank  by  my  colleague,  Frost,  and  myself.  The  cyst  was 
punctured  with  a  trocar  after  it  had  been  brought  into  the 
laparotomy  wound.  This  permitted  it  to  be  removed 
through  a  moderate-sized  opening.  Similar  ovarian  cysts 
occur  in  the  cow,  but  so  far  as  known  do  not  so  frequently 
incarcerate  the  intestines.  They  have  the  general  clinical 
importance  of  benign  ovarian  tumors  and  demand  surgical 
removal  merely  because  of  their  physical  menace  to  the 
health  and  life  of  the  patient.  Since  they  tend  to  cause  in- 
creased size  of  the  ovarian  artery  care  is  necessary  in  their 


Vagi7ial  Ovariotomy  in  the  Mare  263 

removal  to  avoid  danger  from  hemorrhage.  The  arteries 
had  best  be  ligated  with  chromatized  catgut.  Sometimes 
vaginal  ovariotomy  is  practicable.  Usually  it  is  best  to  re- 
sort to  laparotomy  in  the  upper  or  middle  flank  region. 
When  considered  prudent  to  operate  through  the  vagina, 
the  technic  should  be  essentially  that  for  ordinary  ovario- 
tomy. 

Vaginal  Ovariotomy  in  the  Mare 

Instruments.  Colin's  scalpel,  ratchet  ecraseur  55  cm. 
long,  vaginal  tensor. 

Preparation  of  patient.  It  is  best  to  keep  the  animal  on  a 
scant  laxative  diet  for  at  least  24  hours,  and  preferably 
longer,  prior  to  the  operation,  so  that  the  alimentary  canal 
shall  be  somewhat  empty,  thus  decreasing  the  intra-ab- 
dominal tension  and  relieving  the  operator  from  much  an- 
noyance due  to  the  pressure  of  the  viscera.  When  incar- 
ceration colic  is  present,  there  is  of  course  no  opportunity 
to  await  the  general  preparation  of  the  patient.  Before 
commencing  the  operation,  it  is  best  to  have  an  assistant 
empty  the  rectum  manually.  Enemas  should  not  be  em- 
ployed, because  there  is  danger  from  the  expulsion  of  liquid 
feces  during  the  operation.  It  is  best,  also,  to  empty  the 
bladder  before  operating;  otherwise  the  animal  is  quite  sure 
to  urinate  during  the  operation. 

Technic.  The  introduction  of  the  hand  into  the  vagina  of 
the  non-anaesthetized  mare  causes  the  admission  of  air 
along  the  hand  and  arm.  The  vulvar  lips  fail  to  envelop 
the  hand  and  arm  closely  and  the  irritation  or  shock  causes 
the  animal  to  draw  air  alongside  the  arm  into  the  vagina, 
fully  ballooning  it.  The  movements  of  the  diaphragm  and 
chest  walls  tend  to  cause  a  vacuum  of  both  chest  and  ab- 
domen during  inspiration,  and,  if  the  vulva  is  partly  propped 
open  and  the  abdominal  walls  are  fixed,  air  rushes  in.  The 
vagina  may  also  be  distended  by  filling  it  with  warm  water. 
Under  these  conditions  the  vaginal  walls  become  hard,  and 
stand  apart  from  each  other,  closely  applied  against  the 
pelvic  walls  at  every  part  except  at  the  points  where  the 


264  Diseases  of  the  Genital  Organs 

bladder  and  rectum  intervene.  These  organs,  pressed  out 
flat,  occupy  a  minimum  amount  of  space.  In  the  quiescent 
state  the  vaginal  walls  are  in  contact.  From  the  perineum 
forward  to  within  about  10  cm.  of  the  uterine  os,  the  vulva 
and  vagina  are  connected  above  with  the  rectum  by  the  pel- 
vic connective  tissue.  Anterior  to  this  point,  the  vagina  is 
covered  by  peritoneum.  It  is  in  this  area  that  the  incision 
needs  to  be  made  in  the  operation.  The  ballooning  of  the 
vagina  profoundly  alters  the  relation  of  this  operative  area, 
changing  it  from  the  horizontal  in  the  quiescent  organ  to 
the  perpendicular  in  the  ballooned  condition.  These  varia- 
tions permit  of  two  methods  of  operating:  (1)  On  the  bal- 
looned organ  without  anaesthesia  and  with  animal  confined 


Fig.    75 — Special  spaying  ecraseur,  55  cm.  long. 

in  the  standing  position.  (2)  On  the  quiescent  organ  in  the 
recumbent  position  under  anaesthesia  : 

1.  Without  anaesthesia.  Secure  in  the  stocks  with  the 
head  elevated,  a  rope  over  the  back  to  prevent  rearing, 
straps  beneath  the  body  to  prevent  lying  down,  straps  or 
ropes  before  and  behind  the  animal  to  prevent  backward 
and  forward  movements,  all  four  feet  pinioned  to  the  floor, 
and  the  tail  firmly  secured  and  stretched  to  a  beam  above. 
Apply  a  bandage  to  the  tail  extending  12  to  15  inches  from 
its  base,  in  order  to  secure  the  tail  hairs  out  of  the  way  of 
the  operator. 

With  soap,  water,  and  brush  cleanse  the  tail,  porineuni 
and  vulva  thoroughly,  being  especially  careful  to  remove  all 
detachable  masses  of  sebum ;  50  per  cent,  alcohol  or  gaso- 
line may  be  used  sparingly  to  aid  in  removing  this.  Too 
free  a  use  of  alcohol  excoriates  the  delicate  skin.  Cleanse 
the  clitoris  carefully.     Follow  the  washing  with  a  free  sp- 


Vaginal  Ovariotomy  in  the  Mare  265 

plication  of  1:1000  aqueous  sublimate  solution  to  the  exter- 
nal parts  and  for  a  short  distance  inside  the  vulvar  lips  and 
to  the  clitoris.  Do  not  introduce  irritant  disinfectants  into 
the  healthy  vagina  nor  deeply  into  the  vulva,  as  they  may 
cause  severe  straining  during  and  subsequent  to  the  opera- 
tion and,  by  injuring  the  vulvo-vaginal  mucosa,  favor  subse- 
quent infection  of  the  vaginal  wound.  The  vagina  may 
with  benefit  be  flushed  out  mechanically  with  0.6  per  cent, 
salt  or  soda  solution. 

Wash  away  the  sublimate  solution  with  a  tepid  0.6  per 
cent,  soda  bicarbonate  solution,  and  fill  the  vulvo-vaginal 
canal  with  the  same.  After  thorough  disinfection  of  the 
hands  and  arms,  remove  the  disinfectants  by  washing  in 
sterile  soda  solution,  which  at  the  same  time  renders  the 


Fig.  76 — Colin's  scalpel. 

hand  unctuous  and  readily  introduced  through  the  vulva. 
Armed  with  the  guarded  sterilized  scalpel.  Fig.  76,  intro- 
duce the  hand  into  the  vagina  promptly  and  when  the  organ 
is  well  "ballooned,"  unsheath  the  knife.  Place  it  just  above 
the  OS  uteri,  parallel  to  the  long  axis  of  the  uterus,  a  few 
mm.  to  the  right  or  left  of  the  median  line  in  order  to  avoid 
a  loose  fold  of  mucous  membrane  generally  existing  there. 
Hold  the  blade  vertical — that  is,  with  the  cutting  surface 
parallel  to  the  longitudinal  muscular  fibers  of  the  vagina — 
and,  guarding  the  possible  extent  of  its  introduction  with 
the  thumb  and  fingers,  push  it  directly  forward  with  a 
quick  thrust  through  the  vaginal  mucosa,  the  muscular  walls, 
and  the  peritoneum,  until  the  disappearance  of  resistance 
indicates  that  the  latter  has  been  penetrated.  This  is  the 
most  critical  step  in  the  operation. 

If  the  hand  is  introduced  into  the  vagina  immediately 
after  the  injection  of  the  sterile  saline  solution,  the  vagina 


266  Diseases  of  the  Gejiital  Organs 

will  generally  be  found  "ballooned"  or  will  quickly  become 
inflated  under  manual  movements.  If  the  solution  is  thrown 
out,  the  vagina  may  collapse  and  closely  invest  the  hand.  In 
this  case  more  of  the  liquid  should  be  injected,  and  it  will 
again  dilate.  If  the  hand  is  introduced  without  the  knife, 
withdrawn,  and  then  introduced  with  it,  it  will  frequently 
be  found  that  the  vagina  has  collapsed  and  needs  a  second 
filling  with  the  fluid.  Patience  until  dilation  is  accomplished 
and  promptness  to  act  when  it  is  attained  are  prime  requi- 
sites to  success. 

The  knife  should  be  pushed  through  the  vagina  quickly, 
making  a  clean  wound  the  width  of  the  blade,  and  the  latter 
withdrawn  and  laid  aside.  It  should  be  remembered  that  in 
this  "ballooned"  state,  the  anterior  wall  of  the  vagina  is  but 
2  or  3  mm.  thick  and  easily  penetrated.  Introduce  the  hand 
again,  push  one  finger  into  the  incision,  then  a  second  and 
third,  and  eventually,  holding  all  the  fingers  in  the  form  of  a 
cone,  push  the  entire  hand  into  the  peritoneal  cavity.  Im- 
mediately below  the  incision  and  continuous  with  the  tissues 
involved  in  the  wound,  lies  the  uterus,  with  a  transverse  di- 
ameter of  4  to  6  cm.  With  the  palm  of  the  hand  downward, 
trace  the  uterus  forward  15  to  18  cm.,  where  it  ends  abruptly 
in  two  cornua  of  about  the  same  size  as  the  body,  which  are 
given  off"  horizontally  at  almost  right  angles.  Trace  these  to 
the  right  and  left  for  14  or  15  cm.,  where  they  end  obtusely, 
and  3  or  4  cm.  beyond  this  in  a  direct  line,  resting  upon  the 
anterior  border  of  the  broad  ligament  is  the  ovary,  varying 
in  size  according  to  the  degree  of  disease. 

Prepare  the  ecraseur  for  use  by  withdrawing  the  chain 
until  the  loop  is  barely  of  sufficient  size  to  admit  of  its  being 
readily  slipped  over  the  ovary  (or  par-ovarian  cyst  as  de- 
scribed below) .  Grasp  this  loop  and  the  end  of  the  ecraseur 
tube  in  the  hand,  carry  the  instrument  to  the  ovary  or  tu- 
mor, and  drop  the  loop  over  it  from  above.  Pass  some  of 
the  fingers  beneath  the  ovary  or  tumor,  push  it  up  through 
the  chain  loop,  and  grasp  it  there  with  the  thumb  and  index 
finger.  Holding  the  ovary  with  one  hand,  tighten  the  chain 
quickly  with  the  other,  examine  to  make  sure  that  a  loop  of 
intestine  is  not  caught,  draw  the  ovary  well  through  the 


Vaginal  Ovariotomy  iji  the  Mare  267 

loop,  include  a  large  portion  of  the  oviduct,  and  crush  off 
promptly,  holding  to  the  gland  until  carried  out  through  the 
vulva.  If  the  tumor  or  cyst  is  very  large  it  may  not  be 
practicable  to  remove  it  through  the  vaginal  incision.  The 
incision  may  be  enlarged  six  to  ten  inches,  but  after  such 
enlargement  suturing  is  necessary  in  order  to  avoid  pro- 
lapse of  the  intestines.  The  suturing  of  the  vaginal  in- 
cision is  not,  however,  a  serious  task.  The  lips  of  the  wound 
may  be  grasped  by  means  of  long  dressing  forceps  and  held 
firmly  while  the  operator  with  a  short,  curved  needle  closes 
the  incision  by  means  of  a  continuous  suture  beginning  at 
the  anterior  end.  When  the  ovary  is  cystic  or  the  surgeon 
is  dealing  with  a  large  parovarian  cyst,  the  cyst  may  be 
grasped  by  its  peduncle  and  engaged  in  the  vaginal  in- 
cision. The  cyst  may  then  be  punctured  with  a  trocar  or 
scalpel  and  the  liquid  contents  permitted  to  escape  into  the 
vagina  or  through  the  canula  of  the  trocar,  beyond  the 
vulva.  Wash  away  any  blood  from  the  external  parts.  Apply 
sublimate  solution  freely  to  the  vulva,  perineum  and  tail. 
Keep  the  patient  quiet  for  five  or  six  days,  and  feed  lightly 
on  a  laxative  diet. 

2.  In  operating  under  anaesthesia,  the  animal  should  be 
cast  or  confined  upon  the  operating  table  in  lateral  recum- 
bency, preferably  with  the  posterior  part  of  the  body  some- 
what higher  than  the  anterior  in  order  to  avoid  visceral 
pressure  in  the  pelvic  cavity.  Place  the  animal  under  com- 
plete anaesthesia.  Prepare  the  parts  as  already  described. 
Carry  the  knife  into  the  vagina  as  directed  previously  and 
render  the  roof  of  that  organ  tense  by  pushing  the  os  uteri 
downward  and  forward  with  the  hand  or  by  means  of  the 
vaginal  tensor  or  speculum.  It  is  important  that  the  vagina 
be  held  well  down  toward  the  floor  of  the  pelvis,  so  as  to 
carry  it  away  from  the  rectum,  posterior  aorta,  and  iliac 
arteries  while  the  incision  is  being  made.  The  incision  is 
now  to  be  made  just  above  and  behind  and  a  trifle  to  one  side 
of  the  OS  uteri,  in  essentially  the  same  manner  as  under  1, 
except  that  when  the  vaginal  tensor  is  used,  the  cut  is  made 
upward  and  backward  instead  of  directly  forward.     The 


268  Diseases  of  the  Genital  Organs 

remainder  of  the  operation  is  identical  with  what  we  have 
described  under  1.  Under  anaesthesia  the  vagina  is  flaccid 
and  cannot  be  made  to  "balloon"  but  may  be  distended  with 
sterile  soda  or  salt  solution. 

Dangers.  Wounding  of  the  rectum  is  scarcely  possible  un- 
der the  first  method,  if  it  has  been  emptied  as  advised  above, 
if  care  is  taken  not  to  attempt  the  incision  until  the  vagina 
is  well  "ballooned,"  and  the  stab  wound  is  made  directly 
forward.  If  made  upward  when  the  organ  is  so  tensed,  the 
accident  is  highly  probable,  and  with  the  undilated  vagina, 
where  it  is  necessary  to  cut  upward,  the  danger  is  ever 
present.  In  order  to  avoid  this  danger,  when  operating  by 
the  lirst  method,  the  operator  should  await  the  complete 
"ballooning"  and  then  make  his  incision  as  directed.  In  the 
second  method,  the  accident  is  to  be  prevented  by  being  care- 
ful to  push  the  vagina  down  away  from  the  rectum  and  hold 
it  away  while  the  incision  is  being  made.  If  the  wound  in 
the  rectum  passes  through  the  pelvic  connective  tissue  be- 
hind the  peritoneum,  it  is  of  little  consequence,  but  the  oper- 
ation should  be  abandoned ;  if  the  bowel  is  opened  into  the 
peritoneal  cavity,  the  accident  is  generally,  though  not  al- 
ways fatal.  The  vaginal  incision  may  be  enlarged  and  the 
wounded  portion  of  the  rectum  drawn  out  through  the  vulva. 
The  wound  may  then  be  closed  by  sutures. 

Wounding  of  the  iliac  arteries,  which  generally  produces 
prompt  death  from  hemorrhage,  results  from  the  incision 
being  made  upward  instead  of  forward  when  the  vagina  is 
"ballooned"  or  from  a  failure  to  hold  the  roof  of  the  vagina 
down  and  away  from  the  part  while  making  the  incision  in 
the  flaccid  organ,  as  is  the  case  with  the  recumbent  animal 
under  anaesthesia.  It  is  most  likely  to  occur  with  timid 
operators  who  become  nervous,  especially  when  the  vagina 
does  not  "balloon"  promptly  or  the  mare  is  not  well  se- 
cured. The  accident  is  wholly  unnecessary  if  the  operator 
will  await  the  "ballooning"  in  the  first  operation,  while  by 
the  second  method  it  is  prevented  by  proper  care  in  holding 
the  vagina  downward  and  forward  during  the  incision. 
When  it  has  occurred,  it  is  generally  beyond  remedy,  though 


Vaginal  Ovariotomy  in  the  Jlfare  269 

in  some  cases  the  prompt  intravenous  injection  of  adrenalin 
chloride  may  stay  the  hemorrhage  and  save  the  life  of  the 
patient. 

Wounding  of  the  uterus  may  occur  v^hen  the  incision  is 
directed  downward  and  may  greatly  embarrass  the  operator 
and  confuse  him  because  his  fingers  or  hand  may  pass 
through  the  incision  into  the  uterine  cavity.  It  is  to  be 
avoided  in  the  first  operation  (vv^ithout  anaesthesia)  by  care- 
fully directing  the  incision  straight  forward.  When  the 
accident  occurs,  it  is  of  little  consequence  beyond  the  em- 
barrassment and  may  be  overcome  by  again  dilating  the 
vagina  with  fresh  injections  of  the  soda  solution  and  mak- 
ing a  new  incision.  If  preferred,  the  first  cut  may  be  cor- 
rected by  placing  an  index  finger  against  the  peritoneum  at 
the  upper  part  of  the  wound,  and,  with  a  sudden  and  vigor- 
ous thrust,  breaking  through  into  the  peritoneal  cavity,  or 
by  again  using  the  scalpel  and  directing  the  incision  prop- 
erly. If  it  is  attempted  to  rupture  the  peritoneum  with  the 
finger,  this  must  be  done  by  a  sharp  thrust,  since  otherwise 
a  large  section  of  the  membrane  will  be  pushed  away  from 
the  subjacent  tissues. 

Incoviplete  penetration  of  the  vaginal  wall  is  liable  to  oc- 
cur if  the  scalpel  is  dull,  if  the  vagina  is  imperfectly  "bal- 
looned" and  flaccid,  or  if  the  operator  is  unduly  timid.  It 
is  best  prevented  by  avoiding  the  causes  mentioned.  Once  it 
has  occurred,  it  is  generally  best,  in  the  operation  without 
anaesthesia,  to  again  "balloon"  the  organ  and  make  a  new 
incision  either  to  the  right  or  left  of  the  first.  It  may  be 
overcome  also  by  thrusting  the  index  finger  through  the 
peritoneum  as  described  in  the  preceding  paragraph  or  by 
completing  the  cut  with  the  scalpel. 

The  mistaking  of  a  ball  of  feces  for  the  ovary  or  tumor 
has  occurred  to  inexperienced  operators  and  the  fatal  error 
of  removing  the  portion  of  the  rectumsurrounding  the  fecal 
pellet  committed.  The  blunder  is  uncalled  for:  the  fecal 
ball  is  movable  in  the  bowel,  the  intestine  is  far  more  mas- 
sive than  the  broad  ligament,  and  the  ovary  is  to  be  definitely 
identified  by  its  being  lodged  in  the  broad  ligament  just  be- 


270  Diseases  of  the  Genital  Organs 

yond  the  end  of  the  cornua,  which  is  continuous  with  the 
uterus.  If,  therefore,  one  traces  the  uterus  forward  to  the 
cornua,  and  thence  along  each  of  these  to  their  extremities 
and  along  the  borders  of  the  broad  ligament  to  the  ovary,  as 
above  directed,  the  error  will  not  occur. 

The  vaginal  incision  may  be  ynade  too  low  and  pass  be- 
neath the  broad  ligament.  This  is  to  be  avoided  by  being 
careful  to  keep  close  to  the  median  line  and  above  the  os 
uteri.  If  it  occurs,  the  operation  may  be  completed  from  be- 
neath without  very  great  difficulty,  only  that  the  ovary  now 
lies  above  the  hand  and  must  be  drawn  down  from  above 
the  broad  ligament  in  order  to  fix  the  ecraseur  upon  it. 

Infection,  which  always  constitutes  the  most  serious  dan- 
ger, is  to  be  avoided  by  properly  securing  the  animal,  by  the 
avoidance  of  irritant  antiseptics  in  the  vagina,  by  rigid 
asepsis  at  every  stage,  and  by  carrying  out  the  mechanical 
parts  of  the  operation  deliberately,  vigorously,  and  neatly. 
If  infection  should  occur,  it  will  generally  take  the  form  of 
pelvic  cellulitis  with  abscesses  and  rectal  stricture.  Enemas 
of  normal  salt  or  soda  solution  afford  the  surest  relief  of  the 
stricture  and  impaction  in  front  of  it.  The  abscesses  must 
be  watched  and  opened  early  into  the  vagina  or  rectum,  and 
the  case  treated  internally  and  locally  according  to  general 
surgical  principles. 

Vaginal  Ovariotomy  in  the  Cow 

While  vaginal  ovariotomy  is  the  common  method  used  in 
the  cow  and  mare  for  the  simple  purpose  of  removing 
healthy  ovaries  in  castration,  or  of  ovaries  aberrant  in 
function  as  in  nymphomania,  it  is  not  of  great  value  in  the 
removal  of  ovarian  tumors,  since  as  a  rule  they  are  too  large 
for  removal  by  this  route.  Neither  does  the  vaginal  opera- 
tion afford  satisfactory  opportunity  for  controlling  hemor- 
rhage if  increased  vascularity  exists. 

Instruments.  Colin's  scalpel,  vaginal  dilator,  spaying 
ecraseur,  or  emasculator. 

Technic.  Confine  the  cow  in  the  standing  position  in  the 
stocks,  secure  the  head  firmly,  and  pass  two  boards  bonoath 


Vaginal  Ovariotomy  in  the  Cow  271 

the  abdomen  and  sternum  to  prevent  lying  down,  and  a  rope 
over  the  middle  of  the  back  to  prevent  arching  of  the  spinal 
column  and  straining. 

Wash  and  disinfect  the  tail  and  the  perineum  and  flush 
out  the  vagina  with  a  0.5  per  cent,  solution  of  carbolic  acid 
or  lysol  at  a  temperature  of  about  100°  F.  Insert  the  vagi- 
nal dilator  with  one  hand  and  push  the  prolongation  at  the 
anterior  end  into  the  os  uteri.  With  the  other  hand,  elevate 
the  handle  of  the  dilator,  and  depress  and  push  forward  the 
uterus,  thus  rendering  the  roof  of  the  vagina  tense  and  push- 
ing it  downward  away  from  the  rectum.  Carry  the  scalpel 
into  the  vagina  with  the  right  hand  and,  resting  it  in  the 
oval  of  the  dilator,  make  an  incision  through  the  roof  of  the 
vagina,  beginning  at  a  point  8  to  10  cm.  posterior  to  the  os 
uteri  and  extending  backward  on  the  median  line  for  a  dis- 
tance of  2  or  3  cm.  Be  careful  to  make  the  incision  entirely 
through  the  mucosa,  muscle  and  peritoneum  at  the  first  cut, 
since  any  failure  to  complete  it  tends  to  cause  the  perito- 
neum to  separate  from  the  muscular  coat  and  form  a  pocket 
between  them,  while  the  serous  membrane,  being  very  elas- 
tic, renders  it  difficult  to  complete  the  incision.  Introduce 
two  fingers  through  the  incision,  if  the  ovary  is  not  greatly 
enlarged,  and,  reaching  over  the  side  of  the  vagina  to  the 
right  or  the  left,  the  right  or  left  ovary  respectively  is  recog- 
nized, when  normal  in  volume,  lying  immediately  against 
the  lower  part  of  the  base  of  the  uterine  horn,  just  at  the 
anterior  border  of  the  pubis,  in  a  mass  consisting  of  the 
cord-like  Fallopian  tube  and  the  fimbriae  of  its  pavilion. 
When  the  seat  of  an  extensive  tumor  or  cyst,  it  shifts  its  lo- 
cation downward  and  forward  a  variable  distance  according 
to  its  weight.  The  normal  ovary  may  be  distinguished  as  a 
firm  oval  mass  2  to  4  cm.  in  length  and  1  to  2  cm.  in  its  lesser 
diameter  attached  to  the  broad  ligament.  If  not  promptly 
recognized  by  the  sense  of  touch,  trace  the  vagina  and  uterus 
forward  with  the  fingers  from  the  vaginal  incision  to  the 
cornua  and  follow  them  as  they  bend  forward  and  down- 
ward, and  then  backward  and  upward  to  the  oviducts,  until 
the  ovary  is  reached  where  it  is  attached  to  the  broad  liga- 
ment, just  beyond  the  fimbriated  end. 


272  Diseases  of  the  Genital  Organs 

Grasp  the  ovary  between  the  fingers  and,  if  not  too  large, 
draw  it  through  the  incision  into  the  vagina.  Introduce  the 
emasculator  with  the  other  hand,  and,  when  the  ovary  is 
reached,  open  the  instrument  far  enough  to  admit  the  ova- 
rian attachments  between  the  jaws,  push  the  ligament  be- 
tween the  jaws,  close  the  forceps  and  sever  the  ovary.  Or 
introduce  the  ecraseur,  draw  the  ovary  through  the  loop  of 
the  chain  and,  holding  it  securely  until  the  instrument  is 
tightened,  crush  it  off.  If  the  ovary  is  the  seat  of  an  exten- 
sive tumor,  the  hemostatic  power  of  the  ecraseur  or  emascu- 
lator must  not  be  relied  upon.  The  same  is  true  in  a  lesser 
degree  of  nymphomaniac  ovaries.  In  such  cases  it  is  far 
more  prudent  to  ligate  the  artery  with  large  chromatized 
catgut,  passed  through  the  ovarian  ligament  by  means  of  a 
needle.  For  this  purpose  the  ovary  is  drawn  into  the  vagina 
and  its  ligament  engaged  securely  in  a  long  pair  of  forceps. 
The  ligature  is  passed  through  the  pedicle  of  the  tumor  and 
tied  tightly  outside  the  forceps.  The  attachments  are  then 
divided  between  the  ovary  and  the  ligature,  care  being  taken 
to  leave  a  sufficiently  long  stump  to  give  ample  safety 
against  slipping. 

It  is  essential  that  plenty  of  the  broad  ligament  and  ovi- 
duct be  excised  with  the  ovary  to  insure  the  entire  removal 
of  the  gland,  because  the  accidental  leaving  of  the  smallest 
particle  of  ovarian  tissue  may  cause  a  development  of  this 
into  abnormally  large  cystic  ovisacs,  tending  to  increase  in- 
stead of  decrease  nymphomania.  Generally  no  after  care  is 
necessary. 

The  dangers  are  similar  to  those  in  the  mare.  The  iliac 
arteries  may  be  wounded  in  the  same  manner.  The  accident 
is  preventable  by  being  careful  to  push  the  vaginal  roof 
well  downward  away  from  the  rectum  and  sacrum. 

Another  danger  appears  in  the  presence  of  the  rumen, 
the  supero-posterior  portion  of  which,  when  filled  with 
food,  projects  into  the  pelvic  cavity  so  that,  if  the  cut  is 
directed  forward,  a  stab  wound  readily  penetrates  its  walls 
with  fatal  results.     Make  the  cut  upward  and  backward. 


Ovariotomy  in  the  Cozv  and  Mare  by  the  Flank  273 

Ovariotomy  in  the  Cow  and  Mare  by  the  Flank 

Instruments.  Clipping  shears,  convex  scalpel,  spraying 
emasculator  or  ecraseur,  heavy  needle  and  thread. 

The  animal  may  be  secured  as  in  the  preceding  or  con- 
fined in  lateral  recumbency  with  the  hind  legs  extended 
backward  and  the  anterior  limbs  forward.  To  accomplish 
this,  loop  a  rope  about  the  two  fore  feet,  another  about  the 
two  hind  feet,  and,  drawing  upon  these,  cast  the  animal  and 
secure  it  in  recumbency  with  the  legs  extended  and  body 
stretched  by  fastening  the  ropes  to  two  strong  posts  about 
8  to  10  m.  apart.  The  operation  may  be  performed  in  either 
flank.  The  recumbent  animal  should  lie  with  the  diseased 
ovary  uppermost. 

Clip  the  hair  from  the  upper  part  of  the  flank  and 
shave  the  operative  area,  disinfect  an  area  15  to  25 
cm.  square,  make  an  incision  about  12  cm.  long  be- 
ginning at  a  point  equidistant  from  the  anterior  tu- 
berosity of  the  ilium,  the  ends  of  the  transverse  processes 
of  the  lumbar  vertebrae  and  the  last  rib,  and  extend  it 
downward  perpendicularly,  severing  the  skin  and  subcu- 
taneous muscle.  If  the  attachments  of  the  tumor  are  short, 
it  may  be  impossible  to  bring  it  out  through  an  incision  in 
the  upper  flank.  In  such  cases  the  laparotomy  should  be 
performed  in  the  middle  or  lower  flank  region.  Divide  the 
external  oblique  muscle  in  the  direction  of  its  fibres  by 
means  of  the  scalpel  handle  or  the  fingers,  and  repeat  the 
process  upon  the  internal  oblique,  after  which  puncture  the 
peritoneum  with  the  scalpel.  By  thus  dividing  the  external 
and  internal  oblique  muscles,  an  X-shaped  opening  through 
the  abdominal  walls  results,  which  closes  automatically  and 
obviates  the  need  for  peritoneal  and  muscular  sutures.  It 
also  conserves  in  the  highest  measure  the  integrity  of  the 
muscular  walls. 

Force  one  hand  through  the  opening  into  the  peritoneal 
cavity  and  search  for  the  ovary  or  tumor  at  the  same  point 
and  by  the  same  method  as  in  the  preceding  operation :  that 
is,  locate  the  uterus  within  the  pelvic  cavity,  between  the 
rectum  and  bladder,  and  trace  it,  the  cornu,  and  broad  liga- 
18 


274  Diseases  of  the  Genital  Organs 

ment  to  the  ovary.  Then  draw  out  the  diseased  ovary 
through  the  abdominal  incision  and  remove  it  under  ample 
safeguards  against  hemorrhage.  Cleanse  the  v^^ound  and 
close  the  skin  incision  with  continuous  sutures. 

Benign  Tumors  of  Oviducts,  Uterus  and  Cervix 

Benign  tumors  of  the  oviducts,  uterus,  and  cervix  are  ex- 
tremely rare.  I  have  in  my  collection  no  tumors  of  oviduct 
or  cervix  and  but  two  of  the  uterus — one  a  fibroid  from  a 
cow,  the  other  a  myom  from  a  mare.  The  tumor  from  the 
cow  (Fig.  77)  is  from  the  abattoir,  and  hence  without  his- 
tory. It  is  oblong,  of  even  contour,  measures  4x7  inches, 
and  is  located  near  the  apex  of  the  cornu.  The  uterine  walls 
show  no  changes  from  its  presence. 

The  myom  from  the  mare  (Fig.  78)  was  unobserved  until, 
while  at  work,  the  tumor,  which  weighed  eleven  pounds, 
became  dislocated,  and  caused  pain  with  expulsive  efforts 
of  such  violence  that  the  tumor  was  forced  out  through  the 
vulva  and  could  not  be  returned.  The  dragging  upon  the 
uterus  and  its  ligaments  caused  great  suffering.  The  case 
was  entered  in  the  clinic  of  my  colleague.  Frost.  The  tumor 
was  removed,  the  uterine  wound  sutured,  and  the  uterus 
returned  to  its  position.  The  mare  died  a  few  hours  later 
of  hemorrhage  from  the  uterine  artery,  which  was  ruptured 
by  the  violent  dragging  of  the  expelled  tumor.  The  tumor 
measures  5  x  11  inches. 

In  one  case  of  tumor  of  the  uterus,  diagnosed  clinically  as 
a  fibroid,  the  cow  bred  several  times  in  the  opposite  horn, 
but  after  the  tumor  had  reached  a  diameter  of  10  to  12 
inches,  she  became  sterile,  probably  owing  to  the  presence 
of  the  neoplasm. 

Benign  uterine  tumors  may  generally  be  diagnosed  clini- 
cally with  reasonable  assurance.  Ordinarily  the  tumor 
grows  slowly,  causes  no  discharge  or  irritation,  is  not  pain- 
ful upon  manipulation,  is  usually  very  firm,  and  presents  an 
even  contour.  The  malign  tumor  would  generally  give  evi- 
dence of  its  presence  l)y  the  discharge  of  ]nis  and  necrotic 
debris.    The  macerating  fetus  gives  an   irregular  swelling. 


Benign   Tumors  of  Oviducts,   Uterus  and  Cervix 


275 


Fig.  77 — Uterine  Fibroid. 
C,  Cervix  ;    T,  Tumor. 


Cow. 


Fig.  7S— Uterine  Fibroid.     Mare. 

The  dark  periphery  is  due  to  profuse  hemorrhage,  apparently  the  result  of 

contusions  and  the  incarceration  of  arteries  during  prolapse 

of  the  tumor  and  uterus  through  vulva. 


276  Diseases  of  the  Genital  Organs 

the  fetal  bones  are  commonly  palpable,  and  there  is  a  very 
fetid  discharge.  The  desiccating  uterine  hematoma  and  the 
desiccating  fetus  in  its  early  stages  are  less  firm  than  the 
fibroid  and  fill  one  horn  and  uterine  body  from  the  cervix 
to  the  ovarian  end  of  the  cornu.  The  tumor,  on  the  other 
hand,  occupies  but  a  part  of  the  total  length  of  the  uterus. 

When  clinically  recognized  in  valuable  breeding  animals, 
uterine  tumors  should  be  removed  after  performing  laparo- 
tomy, as  indicated  for  spaying  through  the  flank.  If  the 
tumor  can  be  removed  w^ithout  destroying  completely  a 
transverse  section  of  one  cornu,  the  cornu  and  ovary  should 
be  preserved,  but  if  the  removal  of  the  base  of  the  tumor 
w^ill  lead  to  the  occlusion  of  the  lumen  of  the  horn,  the  en- 
tire cornu  on  the  ovarian  side  of  the  tumor,  with  the  ovi- 
duct and  ovary,  should  be  removed.  The  hysterotomy  in- 
cision should  be  closed  by  intestinal  sutures. 

Tumors,  usually  fibroids,  occur  not  rarely  at  the  hymeneal 
ring,  emanating  apparently  from  the  vestiges  of  the  hymen. 
They  are  largely  pedunculated.  They  have  already  been 
referred  to  incidentally  while  considering  vaginal  hernia. 
When  recognized,  they  should  be  removed  by  incarcerating 
the  pedicle  in  a  suture  or  ligature.  It  is  best  to  arm  a  needle 
with  a  strong  suture  and,  exerting  moderate  traction  upon 
the  tumor,  pass  the  needle  deeply  through  the  vulvo-vaginal 
wall  in  a  manner  to  include  the  entire  base  of  the  new- 
growth.  Tie  the  suture  very  firmly,  incarcerating  the  en- 
tire base  of  the  pedicle  and  causing  prompt  necrosis  of  the 
tumor.  The  body  of  the  tumor  may  then  be  excised,  leaving 
enough  of  the  pedicle  to  insure  the  safety  of  the  ligature. 
Do  not  attempt  ecrasement  or  plain  incision  because  of  the 
great  danger  of  vaginal  hernia. 

I  have  observed  two  instances  of  apparently  infectious 
vulvar  benign  epithelioma,  both  in  heifers.  In  one  instance, 
two  heifers  in  contiguous  stanchions  developed  epithelial 
tumors,  or  "warts,"  in  the  vulva.  The  tumors  were  uneven 
and  highly  vascular.  They  were  three  inches  or  more  in 
diameter.  In  the  other  instance,  in  a  group  of  26  heifers 
in  one  lot,  none  of  which  had  copulated,  15  developed  vulvar 


Benign  Tiimors  of  Oviducts,  Uterus  aiid  Cervix  277 

tumors.  The  tumors  were  confined,  so  far  as  could  be  de- 
termined, to  the  interior  of  the  vulva,  largely  at  the  superior 
commissure  and  about  the  meatus  urinarius.  The  tumors 
were  of  every  size  up  to  four  inches  in  diameter.  In  two  or 
three  of  the  heifers  where  the  tumors  were  very  large,  the 
growths  protruded  from  the  vulva,  especially  when  the  ani- 
mal was  recumbent.  The  tumors  caused  no  visible  distress 
or  injury  to  the  animals.  Some  of  the  larger  tumors  were 
removed  after  transfixing  and  ligating  their  bases  with 
strong  sutures.  Much  care  was  necessary  in  one  or  two 
cases  to  avoid  invading  the  meatus  urinarius.  The  tumors 
had  developed  during  the  winter  months  while  the  heifers 
had  been  confined  largely  to  the  stable.  With  the  advent  of 
spring,  with  grazing,  the  new-growths  disappeared  spon- 
taneously. They  behaved  clinically  much  like  the  common 
"warts"  and  the  ringworm  of  the  head  and  face  of  young 
cattle. 


PART  III 

INFECTIONS  OF  THE  GENITAL  ORGANS 
SECTION  I.    THE  GENITAL  INFECTIONS  OF  CATTLE 

CHAPTER  XII 

THE  SPECIFIC  VENEREAL  DISEASES 

1.    The  Vesicular  Venereal  Disease  of  Cattle.    Vesi- 
cular ExANTHEM.    Aphthous  Venereal 
;*'^       Disease.    Blaschenausschlag 

The  vesicular  venereal  disease  of  cattle  is  widespread  in 
continental  Europe,  and  occurs  somewhat  rarely  in  the 
United  States.  It  is  highly  contagious.  Ordinarily  it  is 
transmitted  by  copulation.  After  handling  diseased  ani- 
mals, it  is  readily  transmitted  by  careless  manipulations  of 
the  genitalia  of  healthy  animals,  and  by  grooming  apparatus, 
such  as  brushes,  currycombs,. and  sponges.  It  is  yet  more 
certainly  carried  by  means  of  douching  apparatus  or  other 
instruments  used  in  handling  the  diseased  animal  and  thence 
brought  into  contact  with  the  sound  genital  mucosa  of  an- 
other. It  is  one  of  the  most  intensely  contagious  diseases 
known  to  veterinarians.  Whenever  genital  contact  occurs, 
whether  directly  through  coitus,  or  indirectly  by  such  means 
as  suggested  above,  infection  is  practically  certain.  A  dis- 
eased cow  may  transmit  the  infection  to  her  neighbor  by 
switching  her  tail. 

The  vesicular  venereal  disease  is  analogous  to  the  genital 
horse  pox,  or  vesicular  exanthem  of  horses,  though  they  are 
not  known  to  be  related.  It  bears  some  resemblance  to  the 
chancroid  of  man. 

The  symptoms  are  very  acute  and  marked.  In  thi'  fe- 
male the  disease  appears  suddenly  as  an  intense  vulvt)- 
vaginitis.  The  vulvo-vaginal  mucosa  becomes  greatly  in- 
jected and  swollen.  It  soon  shows  numerous  dark  red  pe- 
techiae,  which  ([uickly  develop  vesicles.    The  vesicles,  which 


The  Vesicular  Venereal  Disease  279 

are  of  short  duration,  either  rupture  as  vesicles  or  become 
pustular  and  rupture,  in  each  case  leaving  an  ulcer.  The 
ulcers,  which  are  one-eighth  to  three-sixteenths  of  an  inch 
or  more  in  diameter,  very  shallow,  and  exceedingly  angry 
in  appearance,  give  rise  to  an  abundant  muco-purulent  dis- 
charge which,  issuing  from  the  vulva,  soils  the  vulvar  labiae, 
the  tail,  and  the  adjoining  parts.  The  vesicles  and  ulcers 
continue  to  develop  in  successive  crops  for  a  number  of  days. 
The  ulcers  heal  with  only  a  very  slight,  temporary  scar. 
Much  pain  is  present.  The  ulcerating  mucosa  is  intensely 
sensitive.  Any  attempt  at  manipulation  causes  very  great 
resistance.  The  ulcers  bleed  freely  upon  touch.  When  un- 
disturbed, the  cow  is  uneasy,  as  shown  chiefly  by  frequent 
switching  of  the  tail  and  more  or  less  stamping  of  the  hind 
feet.  When  urination  occurs,  the  urine,  coming  into  con- 
tact with  the  highly  inflamed  ulcers,  causes  very  marked 
and  intense  pain.  The  animal  switches  her  tail  violently 
and  stamps  the  hind  feet  in  rapid  succession.  Whenever 
the  animal  defecates,  the  mechanical  pressure  unavoidably 
causes  pain,  because  of  the  extreme  tenderness  of  the  vulva 
and  vagina.  The  pain  is  not  as  acute  as  that  observed  in 
urination.  Whenever  the  animal  moves,  the  muscles  of  the 
limbs  which  come  in  close  contact  with  the  vulva  naturally 
drag  upon  the  inflamed  organ,  causing  pain,  which  is  re- 
vealed by  a  stiff"ness  of  gait. 

The  infection  does  not  necessarily  prevent  impregnation. 
If  the  cow  becomes  pregnant,  there  seems  to  be  no  unfavor- 
able influence  upon  the  life  of  the  embryo.  It  is  stated  that 
in  some  cases  the  disease  results  in  chronic  catarrh  of  the 
vagina.  A  commoner,  and  apparently  more  threatening 
termination  is  adhesions  between  the  walls  of  the  vagina, 
which  may  cause  more  or  less  constriction  of  that  canal. 

In  the  bull  the  symptoms  of  the  disease  are  analogous  to 
those  observed  in  the  cow.  The  mucous  membrane  of  the 
penis,  prepuce  and  sheath  becomes  inflamed,  swollen  and 
tender.  The  eruptions  in  the  mucosa  of  the  genital  organs 
are  identical  with  those  observed  in  the  cow.  The  urethra 
may  also  become  involved,  giving  rise  to  a  muco-purulent 


28o  Diseases  of  the  Genital  Orgayis 

discharge  therefrom.  Urination  causes  pain  of  the  same 
general  character  as  that  observed  in  the  cow.  The  swelling 
of  the  penis  and  the  sheath  may  be  so  great  as  to  cause  phi- 
mosis. Erection  of  the  penis  causes  bleeding.  This  is  fur- 
ther emphasized  by  copulation.  Kampmann  records  a  case 
of  extensive  necrosis,  with  permanent  deformity  of  the 
penis,  due  to  this  disease. 

So  far  as  known,  the  disease  does  not  affect  other  species 
of  animals.  The  period  of  incubation  is  brief.  The  course 
of  the  disease  is  brief  and  stormy.  Spontaneous  recovery 
generally  occurs  in  from  ten  to  thirty  days.  It  is  said  that 
no  enduring  or  valuable  immunity  is  acquired,  and  that  an 
animal  may  readily  become  re-infected  by  copulation. 

The  pathogenic  organism  which  causes  the  disease,  as  is 
common  in  diseases  associated  with  vesicles,  is  unknown. 
Ordinarily  an  outbreak  of  the  disease  appears  suddenly  and 
can  not  be  traced  to  other  herds.  Like  genital  horse  pox, 
it  appears  to  develop  spontaneously.  No  suggestion  of  any 
exposure  from  strange  cattle  exists.  Suddenly  the  out- 
break is  present  in  the  stable  in  its  most  acute  and  highly 
contagious  form.  Several  or  many  animals  are  already 
infected.  Once  established,  the  infection  is  readily  traced 
from  animal  to  animal.  It  may  then  spread  to  a  few  neigh- 
boring herds  through  the  agency  of  the  bull,  but  it  is  so  evi- 
dent that  it  is  quickly  observed  by  the  layman,  who  natu- 
rally takes  measures  to  control  it.  The  disease  then  dis- 
appears, until  suddenly  it  reappears  in  some  other  area 
without  any  connection  whatever  being  traceable  between 
one  outbreak  and  another. 

Ordinarily  the  differential  diagnosis  of  the  vesicular  ve- 
nereal disease  is  easy.  At  times  there  has  been  confusion 
with  the  nodular  venereal  disease,  but  this  is  unnecessary. 
The  former  is  characterized  by  vesicles  and  ulcers ;  the  lat- 
ter by  nodules  or  granules,  which  may  be  translucent,  but 
are  hard  and  solid  throughout.  The  nodular  venereal  dis- 
ease is  chronic.  While  there  may  be  a  copious  muco-puru- 
lent  discharge  and  the  affected  parts  may  be  sensitive,  the 
tenderness  is  not  as  marked  as  in  the  vesicular  venereal 


The  Vesicular  Veyiereal  Disease  281 

disease.  The  very  rapid  spread  of  the  vesicular  disease 
serves  also  to  distinguish  it  from  the  virtually  omnipresent 
nodular  venereal  disease. 

The  prognosis  is  highly  favorable.  Recovery  from  the 
disease  is  prompt,  and  almost  always  complete.  It  causes 
small  loss  to  the  dairyman.  The  cow  retains  her  appetite, 
she  does  not  lose  perceptibly  in  flesh,  and  the  milk  supply 
is  not  seriously  disturbed.  Rarely,  especially  following  the 
use  of  strong  antiseptics,  constriction  or  atresia  of  the  va- 
gina may  follow,  which  may  interfere  later  with  copulation 
or  parturition. 

The  control  of  the  disease  must  rest  fundamentally  upon 
isolation,  especially  sexual  isolation.  Since  the  disease  is 
preeminently  venereal  in  character,  breeding  should  be 
completely  suspended  until  all  signs  of  the  disease  in  the 
herd  have  disappeared.  Even  steers  or  oxen  should  not  be 
permitted  to  run  in  pasture  or  in  paddocks  with  cows,  be- 
cause in  attempts  at  copulation  they  might  transmit  the 
disease.  It  is  not  necessary  to  separate  the  diseased  from 
the  healthy  by  any  great  distance.  Close  proximity  should 
of  course  be  avoided,  because  the  disease  might  be  trans- 
mitted from  animal  to  animal  through  the  medium  of  the 
tail  or  soiled  bedding.  Diseased  animals  should  on  no  ac- 
count be  bred  until  they  have  thoroughly  recovered,  and 
even  then  it  is  well  to  use  antiseptic  precautions  just  before 
and  after  breeding.  For  this  purpose,  both  the  vagina  of 
the  cow  and  the  sheath  of  the  bull  should  be  thoroughly 
disinfected  prior  to  permitting  copulation.  The  disinfection 
of  the  sheath  of  the  bull  should  be  repeated  immediately 
after  copulation,  and  the  douching  of  the  vagina  of  the  cow 
may  be  carried  out  within  five  or  six  hours  after  copulation 
and  repeated  occasionally  until  the  attending  veterinarian 
believes  than  any  possible  danger  has  been  eliminated.  The 
thorough  disinfection  of  the  stalls  and  of  the  soiled  parts 
of  the  animals  contributes  materially  to  the  control  of  an 
outbreak. 

The  treatment  of  the  disease  consists  of  the  disinfection 
of  the  copulative  organs  and  of  those  parts  of  the  animal 


282  Diseases  of  the  Genital  Organs 

which  have  become  soiled  from  the  venereal  discharges. 
Disinfection  is  a  difficult  problem  and  must  be  conducted 
with  caution.  The  genital  mucosa  is  in  such  a  highly  irri- 
table state  that  one  can  not  with  success  employ  any  strong 
disinfectant.  It  must  constantly  be  borne  in  mind  that  a 
mucous  membrane  can  not  be  definitely  disinfected  and  that 
any  radical  effort  to  disinfect  will  serve  only  to  irritate  and 
destroy  the  genital  epithelium  and  intensify  the  disease. 
Something  must  be  used  which  is  non-irritant.  It  will  be 
found  that  a  mechanical  cleansing  of  the  parts  with  a  physi- 
ologic salt  solution  will  best  answer  the  purpose.  In  this 
way  the  tissue  debris  and  pus  may  be  washed  away  and  the 
highly  sensitive  ulcers  cleansed  without  inducing  any  ma- 
terial pain.  On  the  other  hand,  the  douching  actually  tends 
to  soothe.  If  the  animal  will  bear  it  without  pain,  very  mild 
antiseptic  solutions  may  be  used  as  a  douche,  such  as  4  per 
cent,  boric  acid.  Whatever  antiseptic  is  selected,  its  action 
should  be  carefully  noted,  and  whenever  it  causes  straining 
its  use  should  at  once  be  discontinued.  If  the  cow  is  not  in 
milk  or  if  the  milk  is  not  to  be  used  for  human  consumption, 
one  may  use  a  dressing  of  10  per  cent,  iodoform  in  oil  in- 
troduced through  a  catheter  or  tube.  If  the  cow  is  being 
milked,  the  use  of  iodoform  inevitably  taints  the  milk  in 
such  a  manner  as  to  render  it  obnoxious. 

In  some  continental  European  states,  the  disease  is  re- 
portable as  a  dangerous  contagion,  subject  to  legal  regula- 
tions. I  have  observed  several  outbreaks,  all  handled  by 
voluntary  personal  quarantine.  The  symptoms  are  so  strik- 
ing that  any  intelligent  breeder  should  realize  that  his  in- 
terests dictate  adequate  control  measures.  Under  the  spe- 
cific laws  for  the  control  of  contagious  diseases  in  most 
states,  it  may  very  properly  be  reported,  and  should  be.  if 
the  attitude  of  the  custodian  threatens  the  extension  of  the 
disease.  I  have  not  known  of  an  outbreak  reported  to  the 
sanitary  authorities  in  America. 


The  Nodular  Venereal  Disease  283 

2.  The  Nodular  Venereal  Disease.  Infectious  Vagi- 
nitis. Vaginitis  Verrucosa,  Metritis  et  Vaginitis 
iNFECTiosus.  Ansteckende  Scheidenkatarrh,  Etc. 
The  classification  of  the  nodular  venereal  disease  as  a 
specific  infectious  malady  is  not  free  from  objection.  Isep- 
poni  of  Chur  (Switzerland)  was  the  first  writer  to  bring 
the  disease  (or  the  lesions)  notably  before  the  veterinary 
profession  as  a  distinct,  specific  malady.  He  was  promptly 
followed  by  numerous  veterinarians.  His  views  were  en- 
dorsed first  by  his  Swiss  colleagues,  and  later  by  Austrian, 
German,  French  and  other  Continental  European  veterina- 
rians. Leading  European  authors — Friedberger  and  Froh- 
ner,  Hutyra  and  Marek,  and  others — assigned  it  a  definite 
place  amongst  infectious  diseases  of  cattle.  The  lesions 
characterizing  the  condition  are  so  nearly  universal  that, 
soon  after  the  publication  of  Isepponi's  observations,  a  few 
veterinarians,  instead  of  considering  it  specific,  held  that  it 
is  in  fact  a  physiologic  condition  and  that  the  absence  of 
the  granules  or  nodules  indicates  disease.  The  dissenters 
were  not  men  of  authority  or  prominence  in  the  profession. 
The  vast  majority  of  veterinarians  in  the  front  rank  ac- 
cepted and  supported  the  teachings  of  Isepponi. 

The  prominence  of  the  nodular  venereal  disease  was 
based  chiefly  upon  the  belief  of  Isepponi  and  his  followers 
that  it  was  responsible  for  most,  or  much,  of  the  sterility 
and  abortion  of  cattle.  Although  sterility  and  abortion  have 
been  recognized  throughout  history  as  a  cause  of  serious 
losses  among  animals,  the  interferences  with  reproduction 
had  reached  a  phase  in  the  time  of  Isepponi  where  they 
were  causing  greatly  increased  concern  to  individuals  and 
to  the  state.  The  views  regarding  the  causes  of  abortion 
were  chaotic  and  the  people  were  so  anxious  to  find  some 
rallying  point  that  they  eagerly  grasped  the  first  plausible 
explanation,  hoping  that  behind  the  recognition  of  the 
cause  lay  a  remedy.  For  about  ten  years  the  belief  in  the 
importance  of  the  nodular  venereal  disease  spread.  This 
belief  rested  upon  clinical  observations.  It  was  held,  by 
those  who  studied  the  problem,  that  the  amount  of  sterility 


284  Diseases  of  the  Geniial  Organs 

and  abortion  in  a  herd  was  parallel  to  the  virulence  of  the 
nodular  venereal  disease.  All  deductions  w^ere  based  upon 
the  presence  or  absence  of  given  lesions. 

Bacteriology  was  making  enormous  strides.  Wherever 
a  distinct  lesion  was  recognized,  search  was  made  for  a 
bacterial  invader  as  a  cause  and  efforts  were  directed  to- 
ward the  experimental  transmission  of  the  disease.  Oster- 
tag,  after  a  brief  bacterial  study  of  the  disease,  reached  the 
conclusion  that  it  was  due  to  a  streptococcus.  No  one  seri- 
ously attempted  to  cause  sterility  or  abortion  experimentally 
by  the  artificial  transmission  of  the  disease.  Wider  ob- 
servation showed  the  lesions  to  be  essentially  omnipresent. 
Many  began  to  doubt  that  these  lesions  could  be  the  cause  of 
sterility  and  abortion,  since  in  that  case  the  bovine  species 
would  be  wiped  out.  Many  were  not  ready  to  believe 
(though  abundant  examples  exist)  that  an  infection  can  ex- 
ist generally  and  only  now  and  then  prove  serious. 

Ten  years  after  the  interesting  observations  of  Isepponi, 
Bang  made  his  famous  discovery  of  the  B.  abortus  and  sur- 
passed in  the  plausibility  of  his  teachings  by  experimentally 
inoculating  pregnant  animals  which  were  assumed  to  be 
free  from  the  B.  abortus  infection.  Some  of  the  experiment 
animals  aborted  and  from  the  uterus  of  the  cow  or  the 
stomach  of  the  abort  Bang  recovered  a  bacterium  which,  it 
was  assumed,  was  the  lineal  descendant  of  the  bacteria  in- 
troduced. The  teachings  of  Bang  quickly  gained  a  promi- 
nent place.  In  the  enthusiasm  which  grew  up,  sterility  was 
essentially  forgotten  or  assigned  a  secondary  place.  The 
nodular  venereal  disease  was  promptly  overshadowed  as  an 
important  genital  infection.  The  B.  abortus  occupied  the 
field  of  thought  in  connection  with  genital  diseases,  and  all 
else  was  consigned  to  oblivion. 

During  the  two  past  decades  little  has  appeared  in  veteri- 
nary literature  concerning  the  nodular  venereal  disease, 
and  that  little  has  been  generally  ignored  or  roundly  con- 
demned. The  disease  is  still  described  in  recurring  edi- 
tions of  the  foremost  treatises  upon  veterinary  medicine, 
rather  as  a  matter  of  habit  than  because  of  any  living  in- 


The  Nodular  Venereal  Disease  285 

terest  in  the  subject.  It  has  never  received,  and  is  not  re- 
ceiving serious  study  at  the  hands  of  pathologists  and  bac- 
teriologists. The  disease  is  accordingly  a  difficult  subject 
with  which  to  deal.  It  may  be  said  to  be  a  lesion  without  a 
known  cause  and  regarding  the  effect  of  which  there  is  very 
scant  knowledge.  I  feel  that  the  disease  should  be  recog- 
nized as  holding  a  definite  place  amongst  the  genital  infec- 
tions, but  do  not  believe  that  at  present  it  should  have  as- 
cribed to  it  that  importance  with  which  Isepponi  and  his 
followers  clothed  it  nor  that  it  should  be  so  utterly  ignored 
as  it  has  been  recently. 

The  nodular  venereal  disease  may  be  described  as  a  vir- 
tually universal,  chronic  infection  affecting  the  mucosa  of 
the  copulatory  area  of  the  genitalia.  It  involves  both  sexes 
and  all  ages  of  ruminants  and  swine.  It  expresses  itself 
clinically  in  the  form  of  granular  or  nodular  elevations  in 
the  mucosa  of  those  parts  participating  in  coitus  (vulva, 
vagina,  sheath,  prepuce,  and  glans  penis). 

The  essential  clinical  symptom  is  the  appearance  in  the 
genital  mucosa,  protruding  above  the  surface,  of  nodular, 
conical,  or  spheroidal  elevations,  usually  1  to  2  mm.  in  di- 
ameter. (See  Figs.  79,  80.)  In  the  female  they  are  best 
observed  clinically  by  holding  the  vulvar  lips  apart  and 
causing  a  strong  light  to  enter  obliquely.  The  examina- 
tion may  be  conducted  advantageously  in  a  well-lighted 
stable,  by  having  the  animal  placed  with  her  posterior  parts 
presenting  toward  a  window  somewhat  above  the  level  of 
her  back.  The  examiner  grasps  each  vulvar  lip  between 
the  thumb  and  fingers  and,  drawing  the  lips  backward  and 
outward,  exposes  the  interior  of  the  vulva  to  vision.  The 
light,  falling  obliquely  into  the  vulvar  cavity,  by  refraction 
brings  the  nodules  clearly  into  view.  In  order  to  examine 
every  part,  the  examiner  should  shift  his  position  again 
and  again,  that  he  may  view  each  area  at  the  proper  angle. 
In  order  to  examine  satisfactorily  the  roof  of  the  vulva,  the 
eye  of  the  examiner  should  be  on  an  approximately  hori- 
zontal line  with  the  mucosa.  Highly  satisfactory  examina- 
tions may  be  made  in  dark  stables  or  at  night  with  the  aid 
of  a  good  reflecting  lamp  or  an  electric  flash  light. 


286 


Diseases  of  the  Genital  Organs 


Vuh 


Fir.    7c.     The  Nodular  Venereal  Disease 

dVuix'n-  l.:n,l  of  Vagina.      Cow.     ( llulyia  and  Mau-k  ). 


The  Nodular  Venereal  Disease 


287 


The  nodules  are  also  recognizable  upon  digital  palpation, 
since  the  elevations  are  very  evident  to  the  sense  of  touch. 
At  times  digital  palpation  may  have  an  advantage  over 
vision,  because  the  mucosa  may  be  edematous  to  such  a  de- 
gree that,  even  when  the  nodules  are  abundant,  they  are 
rendered  invisible. 


/,  Vulvi 


Fig.  80— Mild  Nodular  Venereal  Disease.     Heifer. 

2,  clitoris  surrounded  by  nodules  ;  j,   hymeneal  scar  ;    7,  vagina. 


Under  the  prevailing  conditions  in  American  dairy  herds, 
and  presumably  in  the  dairy  herds  of  the  world,  calves  usu- 
ally develop  clinical  signs  of  the  disease  at  from  four  to 
twelve  weeks  of  age,  and  from  that  time  through  adult  life 
to  old  age  present  a  series  of  interesting  vacillations  of  in- 
tensity, so  great  that  various  writers  have  designated  the 
disease  as  acute,  subacute,  chronic,  cured,  sound,  etc. 

In  the  newborn  heifer  calf,  the  vulvar  mucosa  is  usually 


288  Diseases  of  the  Genital  Organs 

smooth,  moist,  and  pale  rose-colored  for  a  period  varying 
from  four  to  twelve  weeks,  or  even  longer.  Finally,  visual 
inspection  reveals  the  presence  of  several  or  many  spheroido- 
conical  nodules  in  the  vulvar  mucosa,  1  to  2  mm.  in  diameter. 
Usually  they  are  colorless  or  faintly  yellowish  in  the  center 
and  present  the  appearance  of  small,  tense  vesicles,  but 
close  examination  reveals  the  fact  that  they  are  hard  to 
the  touch  and  contain  no  fluid.  Encircling  the  base  of  each 
nodule,  there  is  usually  a  pale  or  bright  red  area  due  to  in- 
creased vascularity,  giving  the  lesion  the  appearance  of  a 
minute  vesicle,  with  a  vascular  girdle.  The  nodules  are 
scattered  here  and  there,  frequently  along  the  floor  of  the 
vulva  in  the  clitorial  region,  but  quite  as  often  on  the  sides 
or  roof  of  the  vulva.  Except  for  the  nodules  and  the  vascu- 
lar girdle  about  the  base  of  each,  the  surface  of  the  mucosa 
in  the  early  stage  is  smooth,  pale  rose-colored,  and  normal. 
There  is  no  swelling,  no  inflammation,  no  discoloration  of 
the  vulvar  mucosa  not  occupied  by  the  nodules,  and  no 
marked  mucous  or  muco-purulent  discharge. 

Slowly  and  insidiously  the  disease  appears  in  calves 
which  have  hitherto  seemed  free,  so  that,  the  older  the 
heifers,  the  larger  the  percentage  showing  evidences  of  the 
infection.  The  rapidity  and  uniformity  of  the  development 
of  the  malady  depend  largely  upon  environment.  Usually, 
in  the  closely  housed  heifer  calves  in  large  dairies,  fed 
carelessly  upon  raw,  mixed  milk,  more  than  90  per  cent, 
show  the  disease  at  four  months,  and  before  they  are  one 
year  old  the  visible  infection  reaches  100  per  cent.  If  by 
any  chance  an  individual  escapes  infection  until  breeding 
age,  the  first  copulation  conveys  the  disease.  In  heifer 
calves  of  the  beef  breeds,  which  nurse  their  dams,  the  in- 
fection develops  much  more  slowly.  In  experimental  heifer 
calves,  I  have  kept  individuals  up  to  six  months,  and  even 
to  one  year  old,  without  any  visible  trace  of  infection. 

The  influence  of  environment  upon  the  spread  of  the  in- 
fection in  heifer  calves  is  further  shown  in  Table  I,  wherein 
the  122  veal  heifers  observed  showed  an  average  infection 
of  Gl   per  cent.    The  percentage  of  iiifcc-tiou  ainoiiy  thcso 


The  Nodular  I'enereal  Disease 


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290 


Diseases  0/  the  Genital  Organs 


calves  is  markedly  below  the  average  among  heifer  calves 
of  corresponding  ages  in  eastern  dairy  herds.  Western  veal 
calves  largely  run  at  liberty  in  the  open,  exposed  only  to  the 
infection  from  their  dams. 

When  the  nodules  are  quite  numerous,  they  tend  to  be- 
come arranged  in  longitudinal,  parallel  rows  corresponding 


I-iG.  Si— Vulva  of  Heifer  Grown  Experimentally  upon  Boiled  Milk. 

The  vulvar  tufl  of  hairs  is  iinstaiin.'(l  and  free  from  muco  pus. 

to  the  longitudinal  folds  of  the  vulvar  mucosa,  as  shown  in 
Fig.  79.  The  nodules  are  located  upon  the  summits  of  the 
rugae,  emphasized  and  rendered  more  distinct  by  the  in- 
flammation of  the  mucosa,  which  causes  it  to  swell,  harden 
and  thicken,  and  forces  it  into  marked  folds.  The  individual 
nodules  change  in  appearance.  They  increase  little  in  size 
and  projection.  The  vascular  areas  about  their  bases  be- 
come more  deeply  injected  and  the  vascularity  may  extend 


The  Nodular  Venereal  Disease  291 

more  or  less  completely  over  the  surface  of  the  nodules,  so 
that  some  of  them  appear  as  bright  red  elevations  or  as 
petechiae  on  the  vulvar  mucosa. 

The  mucosa  itself,  between  the  nodules,  becomes  involved 
and  is  injected,  red,  and  swollen.  With  the  advent  of  defi- 
nite irritation  of  the  vulvar  mucosa,  a  slight  muco-purulent, 


Fig.  82— Vulva  of  Heifer  fed  in  ordinary  manner  as  a  Calf, 

Sliowiui;'  Matting  and  Staining  of  Vulvar  Tuft. 

vulvar  discharge  ensues.  It  is  not  at  first  marked.  Many 
say  it  is  not  present,  or  rather  that  the  discharge  noted  is 
normal.  There  is,  however,  a  visible  discharge  which  so 
mats  together  the  vulvar  tuft  and  surrounding  hairs  in  the 
heifer  calf  that,  in  opening  the  vulva  for  inspection,  the  ex- 
aminer must  frequently  break  down  the  adhesions  between 
the  surrounding  hairs  before  the  vulvar  lips  may  be  parted. 
Some  contend  that  this  is  normal,  but  in  experiment  heifer 


292  Diseases  of  the  Genital  Organs 

calves  such  vulvar  discharge  has  not  appeared  until  after 
visible  infection. 

Up  to  the  date  of  puberty,  or  estrum,  the  nodular  venereal 
disease  of  heifer  calves  generally  behaves  essentially  as  a 
dormant  malady,  without  material  significance  for  the  im- 
mediate welfare  of  the  animal  (See  Fig.  80).  Various  ob- 
servers may  and  do  hold  divergent  views.  Numerous  cases 
are  viewed  by  veterinarians  as  sound  because  of  the  mild- 
ness of  the  symptoms,  but  the  nodules  are  there,  and,  so  long 
as  they  are  admitted  as  the  deciding  lesion  of  the  malady, 
the  heifer  must  be  regarded  as  infected. 

Copulation  is  the  signal  for  the  awakening  of  the  dormant 
infection,  which  then  behaves  like  venereal  disorders  in  ani- 
mals and  in  man  under  the  stimulus  of  sexual  contact. 
Within  twenty-four  hours  after  copulation,  the  evidences 
of  sexual  irritation  are  marked.  The  mucosa  becomes  scar- 
let, swollen  and  tender,  and  in  a  large  proportion  of  cases 
there  is  a  very  notable  muco-purulent  discharge,  which  ad- 
hei'es  to  the  vulvar  tuft  and  soils  the  under  surface  of  the 
tail,  the  skin  of  the  buttocks,  and  the  perineum.  Fre- 
quently the  vulvar  lips  become  markedly  swollen  and  edema- 
tous. If  the  vulvar  lips  are  parted,  the  mucosa  is  seen  to 
be  covered  with  masses  of  stringy,  semi-opaque  mucus,  or 
small  flakes  of  muco-pus  may  be  seen  resting  upon  the 
mucosa. 

After  copulation  the  nodules  multiply  with  astonishing 
rapidity.  Their  arrangement  in  parallel  longitudinal  rows 
becomes  well  marked.  They  are  crowded  into  close  contact 
with  each  other  upon  the  summits  of  the  swollen,  hypertro- 
phied,  mucous  rugae.  Frequently  they  lose  their  trans- 
parency and  assume  a  deep  red  color.  In  every  way  the 
malady  assumes  a  more  decisive  clinical  aspect  of  important 
disease.  Still,  the  general  health  of  the  heifer  is  not  low- 
ered. 

The  intensity  of  the  symptoms  increases  for  a  few  days, 
remains  static  for  a  time,  and  may  then  recede  slightly, 
but  the  improvement  does  not  approach  the  status  main- 
tained prior  to  copulation. 


The  Nodular  Venereal  Disease  293 

Should  the  heifer  become  pregnant  at  the  first  service, 
the  irritation  may  for  a  time  abate  sHghtly  and  slowly,  but 
the  nodules  remain  prominent  and  approximately  as  numer- 
ous as  ever,  and  the  clinical  evidences  of  disease  remain 
essentially  static,  at  one  period  apparently  improved,  at  an- 
other worse,  until  near  the  time  for  parturition,  when  the 
vulvar  mucosa  becomes  more  reddened.  A  marked  edema 
(parturient  edema)  then  appears:  the  nodules  are  covered 
over  and  are  no  longer  visible.  Usually  they  may  still  be 
felt  upon  careful  palpation.  In  many  cases  of  abortion  the 
edema  of  the  vulvar  mucosa  is  essentially  the  same  as  if 
parturition  had  occurred.  If  parturition  or  abortion  is  fol- 
lowed by  retained  placenta  and  chronic  metritis  or  pyome- 
tra,  the  nodules  continue  masked  by  the  persisting  edema 
so  long  as  serious  uterine  or  vaginal  disease  continues. 
Otherwise,  with  the  gradual  disappearance  of  the  edema  of 
the  mucosa,  the  nodules  slowly  come  again  into  view. 

If  the  heifer  fails  to  conceive  at  the  first  copulation,  when 
the  next  estrual  period  arrives  and  copulation  occurs, 
should  the  sterility  be  refractory,  the  symptoms  tend  to 
increase,  so  that  sterile  heifers  are  quite  generally  among 
the  worst  clinical  cases  in  a  herd.  During  the  second  and 
third  pregnancies  the  symptoms  of  the  disease  retain  ap- 
proximately the  average  intensity  acquired  during  the  first 
pregnancy.  Then  the  severity  of  the  malady  generally 
abates. 

When  the  cow  reaches  eight  to  nine  years  of  age  and  her 
sixth  or  seventh  pregnancy,  the  decrease  in  the  intensity 
of  the  disease  generally  becomes  quite  marked:  the  nod- 
ules are  fewer,  less  prominent,  and  more  transparent;  the 
irritation  and  injection  of  the  vaginal  mucosa  are  definitely 
decreased;  and  the  muco-purulent  discharge  has  largely 
abated.  With  advancing  age,  the  vulvar  mucosa  becomes 
pale  yellowish  or  bluish-yellow,  the  nodules  disappear,  and 
the  clinical  evidences  of  the  disease  commonly  vanish  from 
the  vulva  when  the  cow  is  twelve  to  fifteen  years  old. 

Such  is  a  brief  outline  of  the  course  of  the  malady  as  ob- 
served in  a  majority  of  cases,  but  the  course  is  vascillating 


294  Diseases  of  the  Genital  Organs 

and  erratic  in  individuals  and  in  herds.  Copulation  always 
intensifies  the  symptoms,  especially  in  heifers,  and  one  can 
generally  distinguish  by  the  clinical  examination  of  the 
vulva  practically  every  heifer  w^hich  has  copulated  from 
those  which  have  not.  In  some  heifers,  after  repeated  copu- 
lations, the  granules  become  so  numerous  and  highly  in- 
flamed that  coitus  causes  pain  and  hemorrhage,  followed 
by  abundant  vaginal  discharge  for  several  days. 

The  use  of  antiseptics  in  the  vulvo-vaginal  tract  alters  the 
clinical  appearance  profoundly.  Daily  washing  of  the  va- 
gina with  non-irritant,  warm,  antiseptic  solutions  causes 
the  symptoms  of  the  malady  to  decrease  rapidly  in  intensity, 
and  in  a  few  weeks  the  nodules  may  largely  disappear,  the 
mucosa  become  smoother  and  softer,  and  the  color  change 
to  a  pale  rose-red.  It  looks  as  if  the  continuance  of  the 
handling  would  soon  eliminate  the  disease,  but  in  the  end 
some  nodules  remain,  and,  with  a  cessation  of  handling  un- 
accompanied by  copulation,  the  symptoms  remain  static. 
On  the  other  hand,  when  powerful  antiseptics  are  intro- 
duced into  the  vagina,  the  mucosa  becomes  irritated,  swollen, 
and  edematous,  and  the  nodules  thereby  become  veiled. 

Thus  the  clinical  signs  of  the  malady  appear  insidiously, 
usually  when  the  heifer  is  but  a  few  weeks  old.  The  disease 
pursues  a  comparatively  uneventful  course  up  to  breeding 
age,  then  becomes  suddenly  intensified  after  coitus,  and 
quickly  reaches  its  zenith,  where  it  maintains,  with  certain 
vacillations,  an  approximately  horizontal  course  for  three  or 
four  years,  when  it  begins  to  abate  slowly  in  intensity  and 
with  the  advent  of  old  age  more  or  less  completely  disap- 
pears clinically. 

It  will  be  seen  by  a  study  of  the  preceding  table  that 
spayed  range  heifers  of  the  beef  breeds  show  the  disease  in 
a  lower  ratio  than  other  animals,  but  the  ratio  does  not  give 
a  clear  view  of  the  facts.  The  intensity  of  the  disease  de- 
pends very  largely  upon  the  frequency  of  copulation.  The 
spaying  of  range  heifers  was  generally  done  very  carelessly 
and  hastily.  The  operator  thrust  his  hand  through  the 
wound,  grasping  the  ovaries  and  stripping  thoni  from  llu' 


The  Nodular  Venereal  Disease  295 

broad  ligament  between  the  thumb  and  fingers.  The  re- 
sult was  that  in  50  to  60  per  cent,  of  the  animals  some 
ovarian  tissues  were  left,  which  developed  ovisacs  and 
cysts.  The  heifers  came  in  estrum  or  were  nymphomaniac 
and  copulated  freely  with  range  bulls.  In  such  imperfectly 
spayed  animals  the  lesions,  which  were  always  seen,  showed 
considerable  intensity.  In  the  perfectly  spayed  heifers 
the  vulvar  mucosa  was  generally  normal,  smooth,  and  pale 
rose-red,  with  but  few  if  any  visible  nodules. 

Another  striking  illustration  of  the  influence  of  coitus 
upon  the  intensity  of  the  disease  was  observed  in  a  lot  of 
270  two-year-old  range  Hereford  heifers  which  had  evi- 
dently been  kept  away  from  the  bull,  except  in  the  case  of 
one  individual  which  had  copulated  and  become  pregnant. 
In  the  269  non-pregnant  animals,  the  disease  was  quite  uni- 
formly present,  but  only  a  few  nodules  were  seen  in  each 
individual.  Careful  inspection  was  required  lest  they  be 
passed  over.  The  vulvar  mucosa  of  the  one  pregnant  heifer, 
however,  bore  more  of  the  nodules  than  the  other  269  to- 
gether. In  this  one  heifer  the  entire  mucosa  was  swollen 
and  red,  and  dense  masses  of  nodules  crowded  thickly  upon 
each  other. 

Throughout  its  long  course,  the  intensity  of  the  infection 
rises  and  falls,  sometimes  in  obedience  to  known  causes,  as 
copulation,  sometimes  for  reasons  not  yet  understood.  Dur- 
ing the  period  at  which  the  disease  is  at  its  zenith,  few  ani- 
mals fail  to  show  the  clinical  evidences  of  its  presence,  as 
shown  by  Table  I,  according  to  which  the  evidences  of  the 
disease  were  apparent  in  95  per  cent.  This  is  no  higher 
than  regularly  observed  in  dairy  herds. 

The  Nodular  Venereal  Disease  in  Bulls.     Balanitis. 
Balano-Posthitis 

The  nodular  venereal  disease  is  the  basic  cause  of  balani- 
tis, balano-posthitis,  or  akrobustitis,  in  the  bull.  There  can  be 
no  distinction  of  value  between  infections  of  the  sheath,  the 
prepuce,  and  the  mucosa  of  the  glans.  The  continuity  and 
contiguity  of  the  three  areas  render  inevitable  the  extension 


296 


Diseases  of  the  Genital  Organs 


The  Nodular  Venereal  Disease 


297 


of  any  ordinary  infection  from  one  to  the  other.  Various 
mechanical  injuries  may  occur,  and  an  indefinite  variety  of 
infections  may  invade  the  area,  but  the  nodules,  which  are 
already  present,  either  complicate  or  are  complicated  by 
them.  Consequently  it  appears  desirable  to  deal  with  bal- 
anitis as  being  ordinarily  identical  with  the  nodular  vene- 


FiG.  84— Bull  Calf  of  same  age  as  Fig.  83. 
Grown  in  ordinary  manner  on  Raw  Milk,  showing  Matted  and  vStained  Pre- 
putial Tuft.     The  body  hair  is  also  shown  to  be  harsh  and  rough. 


real  disease.  This  does  not  prevent  or  complicate  separate 
consideration  of  rupture  of  the  prepuce  or  other  mechanical 
injuries,  or  of  such  localized  specific  infections  as  actinomy- 
cosis or  tuberculosis,  which  have  already  been  discussed. 

The  inflammation  of  the  sheath,  prepuce  and  mucosa  of 
the  glans,  due  to  the  nodular  venereal  disease,  is  practically 
universal  in  bulls,  but  the  degree  of  inflammation  varies 
widely.    The  ordinary  degree  plays  no  visible  part  in  the 


298 


Diseases  of  the  C.cnital  Organs 


The  Nodular  \'enereal  Disease 


299 


Fig  86-Penis  of  Bull  showing  the  Nodular  Venereal  Disease. 

(From  same  bull  as  Figs.  126,  127.)     /,  Glans  showing  confluent  nodules; 

2,  fornix  ;  j,  the  prepuce  reflected,  showing  solitary  nodules ; 

4,  the  sheath  reflected. 


300 


Diseases  of  the  Genital  Organs 


problem  of  reproduction.  It  existence  is  evidenced  by  a 
discharge  of  muco-pus,  which  flows  from  the  sheath  open- 
ing and  mats  together  the  preputial  tuft  of  hairs,  at  the 
same  time  staining  them  a  dark,  dirty,  brownish-black. 
(See  Figs.  83,  84.)  This  occurs  early  in  the  life  of  the  ani- 
mal, but  the  time  of  its  advent  varies  largely  according  to 
the  environment  and  health  of  the  calf.  In  large  dairy 
herds,  where  sterility,  abortion,  calf  scours,  and  pneumonia 
are  severe,  the  evidences  of  balanitis  occur  with  great  uni- 
formity when  the  bull  calf  is  twenty  to  sixty  days  old,  but 


Fig.  S7— Glans  of  Bull  Showing  Severe  (confluent) 
Nodular  Venereal  Diseases. 

in  the  calves  of  grade  beef  cows,  which  nurse  their  young 
and  live  in  the  open,  the  evidences  of  genital  catarrh  appear 
tardily  and  the  bull  calf  may  reach  four  to  ten  months  of 
age  without  showing  very  marked  evidences  of  matting  and 
discoloration.  Between  these  extremes,  every  possible  grad- 
ation occurs,  and  wide  variations  are  observed  in  individu- 
als confined  in  the  same  stable.  Once  the  matting  and 
staining  have  developed,  they  remain  permanent  throughout 
the  life  of  the  bull.  The  staining  of  the  hairs  is  "fast"  and 
can  not  be  washed  out  by  any  ordinary  means. 


The  Nodular  Venereal  Disease  301 

Inspection  of  the  mucosa  of  the  glans,  prepuce  and  sheath 
reveals  the  presence  of  a  few  or  many  small  nodules,  as  in- 
dicated in  Figs.  85,  86,  87.  The  number  and  appearance  re- 
main static  in  the  calf  up  to  breeding  age.  Coitus  greatly 
increases  the  number  of  granules,  which  tend  to  become 
confluent,  causing  an  enormously  thickened,  roughened  con- 
dition of  the  mucosa  of  the  parts.     Even  with  this  increase 


Fig.  88— Section  of  a  Single  Nodule  from  the  Vestibule  of  the  Vagina. 

Showiug  an  Elevation  in  the  Mucosa.     (Thorns). 

of  the  infection,  there  is  ordinarily  no  notable  interference 
with  coitus  or  fertility.  Now  and  then,  however,  the  parts 
become  so  intensely  inflamed  that  the  bull  hesitates  to  copu- 
late. The  attrition  of  coitus  removes  the  epithelium  from 
the  summits  of  some  of  the  nodules,  creating  minute  abra- 
sions and  inducing  hemorrhage.  In  still  more  severe  cases, 
the  involved  mucosa  becomes  so  swollen  that  the  penis  can 
no  longer  be  protruded,  and  phimosis  becomes  established. 


302  Diseases  of  the  Genital  Organs 

The  history  of  the  nodules  has  been  studied  chiefly  by 
Thorns.  He  found  them  to  consist  of  clumps  of  cells  encap- 
suled  within  the  mucous  membrane.  The  cells,  which  are 
mononuclear,  can  not  be  differentiated  microscopically  from 
ordinary  lymphocytes.  The  capsule  surrounding  the  cell 
mass  is  not  dense,  but  is  well  defined  and  furnishes  no 
stroma.    So  far  as  observed,  no  capillaries  enter  the  cellular 


Fic.  89~Section    through    four  contiguous   nodules  which    cause  a 
single,  rather  flat  elevation  of  the  surface.     (Tlioins. ) 

mass,  but  are  confined  to  the  peripheral  zone,  where  they 
are  large  and  prominent.    (See  Figs.  88,  89,  90.  91.) 

When  the  nodules  are  very  numerous  and  the  mucous 
membrane  is  thrown  into  folds,  the  nodules  projecting  above 
the  surface  of  one  fold  may  come  into  contact  with  those 
from  the  contiguous  ridge,  and,  by  attrition,  the  superficial 
layer  of  epithelium  may  be  worn  away.  It  is  very  largely 
due  to  this  secondary  lesion  that  a  considerable  amount  of 


The  Nodular  Venereal  Disease  303 

muco-pus  is  formed  in  many  severe  cases.    These  attrition 
lesions  are  also  responsible  for  frequent  hemorrhages. 

The  biology  of  the  nodular  venereal  disease  has  not  been 
satisfactorily  determined.  Ostertag  discovered,  in  the 
muco-pus  of  the  vulvae  of  cows,  a  streptococcus  which  he 
believed  to  be  the  essential  cause  of  the  disease.  He  intro- 
duced the  organism,  which  he  had  grown  experimentally, 


Fig.  90 — A  knob-like  elevation  of  the  mucosa  due  to  several 
contiguous  nodules.     (Thorns. ) 

into  the  vulvae  of  supposedly  sound  heifers,  and  believed 
that  he  produced  the  disease.  It  is  a  notable  fact  that  in 
Ostertag's  experiments,  while  he  believed  he  had  trans- 
mitted the  disease  to  cows  and  heifers  by  means  of  pure 
cultures,  he  failed  to  transmit  it  to  sheep,  goats,  and  swine, 
although  they  regularly  suffer  from  it.  It  is  not  clear, 
however,  just  what  he  accomplished.    Doubt  is  thrown  upon 


304  Diseases  of  the  Genital  Organs 

his  findings  by  the  symptoms  and  course  of  the  experi- 
mental disease  which  he  records,  since  they  are  not  the 
symptoms  seen  in  the  first  stages  of  the  disease  as  I  have 
seen  it  in  hundreds  of  heifer  calves  from  two  to  six  months 
old,  as  well  as  in  a  number  of  experimental  calves.  Oster- 
tag  says :  "The  first  symptoms  of  infectious  vaginal  ca- 
tarrh are  swelling  of  the  vulva,  redness,  swelling  and  sensi- 


FiG.  gr— A  section  from  roof  of  the  Vagina  showing  marked  nodule- 
formation  without  macroscopically  visible  elevation 
of  the  mucosa.     (Thonis. ) 

tiveness  of  the  vaginal  mucosa  with  a  muco-purulent  de- 
posit." In  the  earlier  stages  of  the  malady,  as  I  have  ob- 
served it,  there  are  present  none  of  the  symptoms  empha- 
sized by  Ostertag.  On  the  contrary,  the  disease  comes  on 
insidiously.  The  first  sign  is  the  appearance  of  a  few  nod- 
ules in  the  vulvar  mucosa,  sharply  defined  above  the  sur- 
rouding  epithelium,  as  pale  yellow  or  colorless  transparent 
elevations  having  a  vascular  girdle  about  their  bases.    Some 


The  A^odular  Ve7icreal  Disease  305 

would  call  such  heifer  calves  sound,  but,  if  two  or  three 
typical  nodules  do  not  indicate  the  nodular  venereal  dis- 
ease, it  would  be  difficult  to  understand  how  two  hundred 
or  three  hundred  nodules  can  assure  us  of  the  existence  of 
the  malady.  In  other  words,  Ostertag  describes,  not  the  be- 
ginning of  the  disease,  but  an  "explosion"  of  the  existing 
malady  under  profound  irritation.  It  is  not  strange  that 
virulent  streptococci  induced  the  symptoms  he  describes,  nor 
that  he  was  able  to  recover  from  his  experimental  animals 
pure  cultures  of  the  microorganism. 

The  disease  is  so  universal  that  an  investigator  is  not 
warranted  in  assuming  that  a  given  heifer  or  heifer  calf  is 
not  affected.  Calves  born  during  severe  outbreaks  are  fre- 
quently so  badly  diseased  that  they  die.  Therefore,  it  is  not 
unreasonable  to  assume  that  in  some  cases  at  least  calves 
are  born  with  the  nodular  venereal  disease.  Extended  ob- 
servations upon  the  genital  organs  of  veal  calves  upon  the 
killing  floors  of  abattoirs  show  that  almost  all  of  them  de- 
velop clearly  and  positively  the  symptoms  of  the  disease  at 
a  very  early  age,  usually  within  sixty  days  after  birth.  It 
is  not  known,  however,  when  the  infection  really  became 
established,  but  only  when  the  clinical  evidences  became 
visible  to  the  naked  eye.  Recent  investigations  indicate 
that,  assuming  that  the  calf  is  sound  when  born,  which  is 
not  the  general  rule,  it  remains  free  from  the  nodular  ve- 
nereal disease  if  fed  upon  boiled  milk.  Such  being  the 
case,  it  would  appear  that  the  infection  may  enter  the  or- 
gans of  new-born  calves  with  the  first  milk  consumed,  and 
that  the  appearance  of  visible  lesions  in  the  genital  tract 
merely  marks  the  duration  of  time  between  the  ingestion  of 
the  infection  and  the  establishment  of  the  clinical  evidences 
of  its  presence.  Accordingly,  any  calf  which  may  be  se- 
lected for  experimental  purposes,  with  a  view  to  determin- 
ing the  transmissibility  of  the  nodular  venereal  disease  or 
the  power  of  any  known  organism  to  cause  it,  can  scarcely 
be  accepted  as  sound,  because  it  is  not  known  how  thor- 
oughly the  calf  is  already  infected  and  upon  what  day  the 
evidence  of  such  infection  would  ordinarily  appear  in  the 


3o6  Diseases  of  the  Genital  Organs 

genital  tract.  It  is  not  known  that  these  lesions  in  the  geni- 
tal tract  are  the  sole  or  primary  lesions  of  the  disease.  Va- 
rious writers  have  asserted  that  these  lesions  have  been  dis- 
covered in  the  uterine  mucosa,  and  that  the  streptococci  have 
even  been  found  in  the  ovaries.  Streptococci  are  common  in 
the  genital  tracts  of  animals.  The  streptococcus  which  Os- 
tertag  has  described  does  not  differ  materially,  so  far  as 
may  be  learned  from  his  description,  either  in  staining  or  in 
cultural  behavior,  from  other  streptococci.  On  the  whole, 
therefore,  the  evidence  relating  to  the  biology  wants  some 
of  the  essentials  for  arriving  at  a  safe  conclusion.  When 
the  nodules  increase  they  do  so  numerically,  and  when  first 
observed  are  of  full  size.  When  they  disappear,  they  van- 
ish numerically,  but  those  which  remain  are  essentially  as 
large  as  ever. 

The  Relatio7iship  of  the  Nodular  Venereal  Disease  to 
Sterility  and  Ahortion.  Isepponi,  Zschokke,  Hess,  and  many 
others  were  thoroughly  convinced  that  this  infection  was 
the  cause  of  abortion,  sterility,  and  other  diseases  of  the 
genital  organs  of  cows.  The  evidence  which  they  submit  is 
clinical,  and  in  large  measure  circumstantial.  When  abor- 
tion breaks  out  in  a  serious  form,  veterinarians,  seeking  for 
an  explanation,  tend  always  to  search  for  any  evidence 
which  may  offer  an  acceptable  hypothesis  for  the  occurrence 
of  the  disaster.  If  the  nodular  venereal  disease  has  been 
accepted  at  a  given  time  or  in  a  given  country  as  the  re- 
sponsible cause  of  abortion  and  allied  disasters,  the  exam- 
iner is  very  liable  to  look  closely  for  these  lesions,  and  when- 
ever he  does  so  he  is  certain  to  find  them.  He  then  as- 
sumes that  the  cause  of  the  disaster  is  revealed,  and  does 
not  investigate  carefully  the  character  of  his  evidence.  In 
fact,  the  definition  of  nodular  venereal  disease,  as  given  by 
various  observers,  differs  widely.  As  a  general  rule  the 
diagnosis  is  not  based  upon  the  appearance  of  nodules  in 
the  vulvar  mucosa,  but  rather  upon  the  number  of  nodules 
and  their  clinical  appearance.  Hess,  for  example,  says  that 
an  animal  has  the  nodular  venereal  disease  when  there  is  a 
large  number  of  the  nodules  present  in  the  vulvar  mucosa 


The  Nodular  \'enereal Disease  307 

and  muco-pus  upon  the  inflamed  mucosa.  The  number  of 
nodules  necessary  to  warrant  the  term  "numerous,"  the 
amount  of  inflammation  necessary  to  warrant  the  diagno- 
sis of  inflammation,  or  the  amount  of  muco-pus  necessary 
for  recognition  as  such,  varies  with  each  observer.  In 
Bulletin  106  of  the  United  States  Department  of  Agricul- 
ture, I  took  as  my  basis  for  diagnosis  the  visible  existence 
of  nodules  in  the  vulvar  mucosa.  If  nodules  were  present, 
were  they  two  or  three  or  even  only  one,  if  they  were  typi- 
cal, I  classed  the  individual  as  infected ;  if  I  failed  to  recog- 
nize any  of  the  lesions,  I  classed  it  negative. 

Whenever  sterility  and  abortion  are  highly  virulent  in  a 
herd,  the  nodular  venereal  disease  is  intense ;  whenever  the 
rate  of  abortion  is  very  low,  there  is  a  correspondingly  low 
intensity  of  the  nodular  venereal  disease.  This  parallelism 
is  very  striking  and  suggestive.  It  constitutes  evidence  of 
a  possible  relationship  between  this  infection  and  the  breed- 
ing disasters,  which  should  not  be  ignored.  However,  it  is 
merely  a  bit  of  interesting  evidence — not  proof. 

It  has  been  stated  by  some  observers  that,  with  the  ad- 
vent of  the  disease  in  a  herd  of  cows,  abortion  broke  loose 
as  a  storm.  The  truth  of  the  matter  is  that  the  infection 
was  discovered  after  the  outbreak  of  the  abortion.  There 
is  no  good  reason  to  assume  that  it  had  not  existed  in  the 
herd  from  the  very  beginning.  No  search  was  made  for  it 
until  the  abortion  storm  broke ;  then  observation  revealed 
its  presence,  and  the  disease  was  attributed  to  it. 

Some  observers  have  recorded  that  in  outbreaks  of  abor- 
tion in  sows  a  clinical  examination  revealed  the  presence  of 
the  nodular  venereal  disease.  Hence  it  was  said  that  the 
disease  had  been  transmitted  from  cows  to  sows  and  that 
thereupon  "contagious  abortion"  broke  out.  Thus  it  has 
been  claimed  that,  wherever  the  nodular  venereal  disease 
appears,  extensive  losses  from  abortion  must  follow.  Had 
the  observers  taken  the  precaution  to  examine  the  genital 
organs  of  supposedly  healthy  sows  in  herds  where  abortion 
did  not  prevail,  there  also  the  disease  would  have  been 
found. 


3o8  Diseases  of  the  Geiiital  Organs 

Under  the  circumstances,  it  seems  perfectly  clear  that 
the  nodular  venereal  disease  has  not  been  proven  to  be  the 
direct  cause  of  sterility  or  abortion  in  cattle  or  in  other  do- 
mestic animals.  Whether  it  does  or  does  not  directly  cause 
sterility  or  abortion,  clinical  evidence  indicates  clearly  that 
it  is  a  disease  which  merits  the  respectful  attention  of  in- 
vestigator, practitioner,  and  breeder. 

The  avenue  and  date  of  infection  are  not  clear.  In  large 
dairies,  rich  in  genital  infections,  the  evidences  of  the  pres- 
ence of  the  nodular  venereal  disease  are  well  established  at 
thirty  to  sixty  days  after  birth.  This  shows  clearly  that  the 
primary  infection  is  not  due  to  coitus.  Careful  observa- 
tion also  indicates  that  the  infection  is  not  generally  refer- 
able to  intermediary  bearers  such  as  attendants  or  stable 
equipment.  Neither  can  it  be  ascribed  to  ordinary  cohabi- 
tation with  other  calves  or  cattle,  since  calves  confined  in 
isolated  stalls  suffer  the  same  as  other  animals.  Experi- 
mentally I  have  kept  calves  in  close  proximity  to  diseased 
cattle,  all  cared  for  by  the  same  attendant,  with  no  special 
precautions,  without  any  evidence  of  transmission.  My 
experiments  indicate  with  great  emphasis  that  the  infec- 
tion which  appears  so  uniformly  in  the  young  calf  is  blood- 
borne  from  the  alimentary  or  pulmonary  tract,  and  its  de- 
velopment may  be  accelerated,  controlled,  or  prevented  at 
will  by  the  method  of  feeding.  When  the  grade  beef  cow 
nurses  her  calf  in  the  open  field,  it  does  not  so  promptly 
nor  so  markedly  develop  evidences  of  infection.  The  higher 
the  intensity  of  calf  scours  and  pneumonia  in  a  stable,  the 
more  prompt  and  intense  are  the  evidences  of  the  nodular 
venereal  disease.  When  the  health  of  the  calf  is  better,  but 
there  are  adhesive  feces,  a  rough  lustreless  coat,  pot-belly, 
and  a  hacking  cough,  the  advent  of  the  genital  catarrh  is 
later  and  less  marked.  If  the  calf  is  born  in  good  health, 
and  diarrhea,  indigestion,  hacking  cough  and  general  un- 
thrift  are  avoided,  the  evidences  of  the  {lisoase  do  not  aji- 
pear  for  several  months. 

While  it  has  not  been  proven  that  the  nodular  venereal 
disease  is  the  cause,  or  an  important  cause,  of  sterility  or 


The  Nodular  Venereal  Disease  309 

abortion,  it  is  still  true  that  sterility,  abortion  and  calf  dys- 
entery run  parallel  with  the  nodular  venereal  disease. 
Calves  thirty  to  sixty  days  old  do  not  suffer  from  dysentery 
or  pneumonia  if  they  are  free  from  the  clinical  evidences  of 
the  nodular  venereal  disease.  New-born  calves  break  down 
with  dysentery  before  the  signs  of  the  nodular  venereal  dis- 
ease are  established.  If  the  evidences  of  the  disease  are 
present,  the  calf  exhibits  one  or  several  of  the  following 
symptoms :  dysentery,  torpidity  of  the  bowels  alternating 
with  diarrhea,  sticky  feces  adhering  to  the  hairs  of  the  tail 
and  buttocks,  pneumonia,  a  hacking  cough,  lustreless  coat, 
and  pot-belly.  When  such  a  calf  reaches  breeding  age,  its 
fertility  is  uncertain. 

It  is  highly  interesting  to  observe  that,  in  applying  the 
agglutination  test  for  B.  abortus  to  the  blood  of  calves,  the 
reactions  are  parallel  to  the  manifestations  of  the  nodular 
venereal  disease:  the  blood  of  calves  severely  infected  re- 
acts highly  to  the  B.  abortus  test,  and  vice  versa.  The  sig- 
nificance of  this  parallelism  is  undetermined.  By  no  means 
does  it  show  that  the  B.  abortus  is  or  is  not  the  cause  of  these 
lesions.  It  is  not  known  to  what  degree  blood  samples  from 
the  same  animals  may  react  to  the  agglutination  test  for  the 
streptococci,  colon-like  bacilli,  micrococci,  and  other  bacte- 
ria commonly  recognized  in  the  genitalia  of  cattle. 

The  most  important  consideration  regarding  the  nodular 
venereal  disease,  pending  scientific  study  of  the  problem,  is 
that  it  causes  important  disease  of  the  copulatory  mucosa 
(balanitis,  posthitis,  colpitis,  vaginitis)  which  produces  def- 
inite injury.  Frequently  the  disease  is  so  severe  that  it 
causes  recognizable  pain  in  coitus,  followed  by  hemorrhage 
owing  to  the  summits  of  the  nodules  becoming  removed  by 
attrition.  Each  of  the  multiple  small  abrasions  constitutes 
an  open  and  inviting  avenue  for  infection  by  any  agent  pres- 
ent. In  the  bull  the  mucosa  may  be  so  severely  swollen  that 
phimosis  is  established  and  coitus  is  barred.  The  vulva  of 
the  heifer  is  frequently  so  inflamed  that  it  bleeds  under 
gentle  digital  palpation,  and  the  vulvo-vaginal  mucosa  is 
covered  over  with  much  stringy,  tough  muco-pus.    What- 


3IO  Diseases  of  the  dcnital  Organs 

ever  may  be  the  final  decision  as  to  the  significance  of  the 
nodular  venereal  disease,  these  definite  injuries  should  be 
recognized  and  preventive  or  ameliorative  measures  applied. 

The  prognosis  of  the  nodular  venereal  disease  is  good.  It 
can  not  be  definitely  cured  by  any  known  means,  but  it  may 
be  controlled  and  its  power  for  harm  mitigated.  It  is  im- 
practicable at  present  to  prevent  it  wholly,  but  the  proper 
handling  of  new-born  calves  does,  for  all  practical  purposes, 
render  it  harmless  so  far  as  now  known.  The  handling  of 
the  nodular  venereal  disease  is  based  upon  application  of 
adequate  measures  for  the  healthy  rearing  of  calves  and  for 
sex  hygiene  in  adults. 

Considering  the  nodular  venereal  disease  as  one  which  at- 
tacks the  new-born  calf  and  continues  throughout  the  ani- 
mal's life,  the  most  fundamental  necessity  is  to  grow  the 
calf  so  that  the  infection  will  not  develop  in  a  serious  form. 
This  can  be  done  only  by  strict  attention  to  the  feeding  and 
other  hygienic  questions,  which  will  be  more  thoroughly 
discussed  in  Section  3  of  Part  III,  under  "Congenital  In- 
fections of  Calves."  Here  the  invasion  may  be  controlled 
in  such  a  manner  that  it  tends  to  protect  the  animal  against 
the  more  severe  type  of  the  disease  during  its  adult  life. 

The  disease  is  so  highly  infectious,  however,  that  the  ul- 
timate control  must  include  proper  sex  hygiene  in  the  adult 
of  each  sex.  In  the  bull  the  handling  of  the  nodular  vene- 
real disease  resolves  itself  into  the  control  of  balanitis,  or 
balano-posthitis.  Here  handling  should  be  preventive  or 
controlling  rather  than  curative.  It  is  just  as  necessary  to 
control  the  disease  from  the  standpoint  of  secondary  as  from 
that  of  the  primary  disease  itself.  If  the  disease  is  per- 
mitted to  acquire  great  intensity,  so  that  the  summits  of 
the  nodules  become  denuded  of  their  epithelium,  a  gateway 
for  various  infections  is  opened,  imperiling  the  sex  health 
of  the  animal.  The  breeding  bull  should  always  be  viewed 
from  the  standpoint  of  a  male  which  is  expected  to  copulate 
with  an  indefinite  number  of  females,  each  of  which,  since 
she  may  bear  infections  within  her  genital  tract,  is  a  poten- 
tial danger  for  the  male.  He  in  turn,  after  such  exposure, 
carries  an  e(iual  peril  for  the  female. 


The  Nodular  Veyiercal  Disease  311 

The  handling  of  balanitis  consists  essentially  of  cleanli- 
ness. It  has  been  stated  that  genital  catarrh  is  essentially 
universal  in  bulls.  While  its  presence  has  been  ignored 
generally,  there  should  be  no  doubt  regarding  its  importance 
in  relation  to  the  reproductive  functions.  Whenever  the  ca- 
tarrh becomes  at  all  advanced,  the  epithelium  upon  the  sum- 
mits of  the  granules  or  nodules  becomes  damaged  and  af- 
fords an  avenue  for  the  entrance  of  other  infections.  It  is 
probably  largely  through  these  lesions  that  primary  genital 
tuberculosis  is  established,  as  has  already  been  stated  in 
Chapter  XIII.  Consequently  it  is  important,  for  the  sexual 
health  of  both  the  bull  and  the  cows  with  which  he  copu- 
lates, that  the  genital  catarrh  shall  be  held  in  abeyance  at 
all  times  and  not  permitted  to  become  so  exaggerated  as  to 
interfere  with  coitus.  According  to  present  knowledge,  it 
seems  highly  probable  that,  when  the  genital  catarrh  of  the 
bull  becomes  severe,  its  existence  must  be  inimical  to  the 
welfare  of  the  female  with  which  he  copulates.  The  infec- 
tion, introduced  deeply  into  the  vagina,  necessarily  remains 
behind,  adding  to  the  infection  already  present.  While  we 
do  not  know  the  exact  significance  of  the  infection,  it  is  im- 
possible to  conclude  otherwise  than  that  it  is  detrimental. 

The  best  method  at  present  available  for  maintaining  the 
health  of  the  prepuce,  sheath  and  glans  is  by  douching  the 
parts  at  frequent  intervals,  say  two  or  three  times  a  week, 
when  the  bull  is  at  rest,  and  thoroughly  douching  the  parts 
just  prior  to  and  immediately  following  each  service.  The 
best  apparatus  for  carrying  out  the  douching  plan  is  an  or- 
dinary agate  hospital  irrigator  of  one  gallon  capacity,  to 
which  a  pure  gum  douching  catheter  is  attached.  This  in- 
strument, the  diameter  of  the  ordinary  horse  catheter  and 
seven  feet  long,  has  the  end  rounded  so  that  it  may  be  intro- 
duced freely  and  safely  into  the  sheath  and  prepuce.  It  is 
made  of  pure  soft  rubber,  which  is  smooth,  pliable,  and  re- 
sistant to  hot  water,  so  that  it  may  be  repeatedly  boiled  for 
purposes  of  sterilization'. 

1  Upon  my  request,  the  firm  of  Sharp  &  Smith,  Chicago,  have  placed  in 
stock  a  catheter  of  the  dimensions  stated.  It  is  of  sufficient  length  that, 
when  the  irrigator  is  suspended  above  the  bull,  it  is  abundantly  long  for  in- 
sertion into  the  sheath. 


3 1 2  Diseases  of  the  Genital  Organs 

The  technic  of  douching  is  very  simple.  The  irrigator  is 
filled  with  a  warm  physiological  salt  solution  ( 1  oz.  common 
salt  to  1  gal,  water)  to  which  may  be  added  with  benefit  i/i 
of  1  per  cent,  of  Lugol's  solution.  The  irrigator  is  then  sus- 
pended two  or  three  feet  above  the  back  of  the  bull  and  the 
catheter  gently  inserted  through  the  sheath  into  the  prepuce. 
The  insertion  is  facilitated  by  the  application  of  a  small 
amount  of  lard  or  oil.  The  douching  fluid  should  be  allowed 
to  flow  slowly  from  the  catheter  before  it  is  inserted  into 
the  sheath,  in  order  that  all  air  bubbles  shall  be  forced  out. 
Once  introduced,  the  fluid  is  permitted  to  flow  freely  into 
the  sheath  and  prepuce.  At  the  same  time,  the  operator 
should  grasp  the  opening  of  the  sheath  and  compress  it  so 
that  the  fluid  may  not  escape.  This  causes  the  sheath  and 
prepuce  to  become  thoroughly  distended,  the  many  complex 
longitudinal  folds  of  the  mucous  membrane  to  become  ob- 
literated, and  the  fluid  to  come  in  contact  with  every  part. 
When  the  sheath  has  become  thoroughly  distended,  the 
operator  should  suddenly  release  the  compression  on  the 
sheath  opening  and  permit  the  fluid  to  escape.  As  soon  as  it 
has  all  escaped,  he  should  again  compress  the  mouth  of  the 
sheath  and  repeat  the  operation  several  times,  in  order  to 
insure  thorough  mechanical  washing. 

In  numerous  publications  from  apparently  authentic 
sources,  directions  are  given  for  douching  the  sheath  and 
prepuce  of  bulls,  of  which  it  is  impossible  for  me  to  approve. 
Writers  frequently  state  that  the  douching  can  be  carried 
out  successfully  by  using  a  piece  of  ordinary  rubber  tubing. 
In  my  judgment  this  is  not  true.  The  ordinary  rubber  tub- 
ing is  mixed  with  lead  and  other  diluents  which  render  it 
very  rigid  and  harsh.  Since  the  end  is  cut  squarely,  and 
frequently  roughly,  any  attempt  to  push  the  tubing  into  the 
upper  part  of  the  sheath  and  into  the  prepuce  inevitably 
abrades  the  mucosa.  I  think  the  use  of  a  piece  of  ordinary 
rubber  tubing  can  not  be  too  strongly  condemned.  If  the 
work  is  worth  doing  at  all,  it  should  be  done  in  a  surgical 
manner  with  an  appliance  suitable  for  the  task. 

Another  very  common  error,  according  to  my  \  icw.  is  the 


The  Nodular  Venereal  Disease  313 

advice  of  some  writers  that  a  force  pump  should  be  used  for 
douching.  A  pump  is  exceedingly  difficult  to  keep  clean. 
It  almost  inevitably  becomes  dirty.  Most  pumps  are  not 
subject  to  disinfection  or  to  sterilization  by  boiling.  With  a 
pump  there  is  always  danger  of  including  in  the  douching 
fluid  air  bubbles,  which  may  flow  into  the  sheath  and  pre- 
puce under  great  force,  giving  the  animal  a  shock  which 
causes  him  to  move  suddenly  with  danger  of  injuring  both 
himself  and  the  operator.  The  pump  is  also  an  extravagant 
appliance.  With  the  irrigator,  the  douhcing  can  be  carried 
out  readily  by  one  man,  whereas  with  the  force  pump  two 
men  are  necessary.  Ordinarily  a  bull  is  well  accustomed  to 
one  man,  and  that  one  can  manage  him  better  alone  than  in 
the  presence  of  others. 

It  is  frequently  asserted  that  certain  bulls  will  not  permit 
the  douching  without  violent  and  stubborn  resistance.  I 
have  not  found  this  to  be  true.  Repeatedly,  caretakers  have 
been  exceedingly  dubious  about  their  ability  to  douche  the 
bull,  but  with  such  an  apparatus  as  I  have  described,  and 
with  ordinary  prudence  in  handling  the  animal,  I  have 
found  that  the  douching  can  be  carried  out  without  violence 
on  the  part  of  the  animal.  He  will  stand  for  the  douching 
as  well  as  for  grooming.  The  success  of  the  douching  de- 
pends upon  gentleness  and  tact  on  the  part  of  the  operator 
and  his  having  at  hand  suitable  equipment  for  the  work. 
Failures  in  douching,  so  far  as  I  have  known,  have  always 
been  due  to  lack  of  proper  apparatus  or  to  faulty  method, 
or  in  some  cases  to  faulty  solutions  used.  The  douching 
fluid  should  always  be  warm — not  hot — and  should  be 
wholly  free  from  irritation.  Some  writers  advise  a  strong 
disinfectant.  These  always  prove  highly  irritant  and  serve 
to  infect  instead  of  disinfect.  That  is,  an  irritant  disinfect- 
ant introduced  into  the  sheath  and  prepuce  destroys  the 
protective  epithelium  of  the  part,  and  the  dead  cells  re- 
maining supply  a  new  and  fertile  field  for  the  multiplication 
of  bacteria.  It  is  impossible  to  disinfect  wholly  the  genital 
mucosa,  and  no  such  vain  attempt  should  be  made.  Instead, 
a  high  degree  of  mechanical  disinfection  should  be  obtained 
by  using  a  neutral  or  slightly  bactericidal  douche. 


3H 


Diseases  of  the  Genital  Organs 


When  the  balanitis  becomes  severe  and  coitus  becomes 
difficult  or  impossible,  the  douching  should  be  carried  out 
diligently,  once  or  twice  a  day,  according  to  conditions. 
Great  care  should  be  taken  not  to  use  an  irritant  douche. 
There  is  a  great  tendency  among  some  veterinary  practi- 
tioners, when  the  infection  of  the  sheath  and  prepuce  be- 
comes marked,  to  attempt  to  disinfect  with  some  very  pow- 
erful solution.  These  only  intensify  the  disease  present.  In 
one  case  where  I  was  consulted,  the  attending  veterinarian 
had  used  10  per  cent,  silver  nitrate,  5  per  cent,  compound 
cresol,  a  strong  solution  of  lysol,  and  other  disinfectants. 
Each  change  was  for  the  worse  and  the  highly  valuable  bull 
had  been  pronounced  incurable  and  slaughter  advised.  A 
mild  douche,  such  as  advised  above,  ameliorated  the  symp- 
toms very  promptly.  Within  fifteen  days  the  bull  was  back 
at  work  in  prime  condition,  and  remained  competent  and 
fertile. 

Whenever  balanitis  is  severe,  a  bull  should  be  taken  out  of 
service  and  kept  as  free  from  sexual  excitement  as  possible 
until  the  severe  symptoms  have  abated. 

The  general  principles  in  controlling  the  disease  in  the 
female  are  essentially  the  same  as  in  the  male.  In  breeding 
heifers  for  the  first  time,  it  is  important  and  prudent  to  ex- 
amine the  vulva  and  vagina  carefully,  in  order  to  determine 
the  intensity  of  the  disease.  Frequently  it  is  found  to  be  so 
intense  that  there  is  considerable  muco-pus  present  before 
coitus  has  occurred.  If  such  be  the  case,  it  is  important  that 
the  intensity  should  be  ameliorated  by  flushing  the  vagina 
three  or  four  times  a  week  with  a  warm,  physiologic  salt 
solution,  to  which  has  been  added  i/4  to  Vi  per  cent,  of  Lu- 
gol's  solution  or  of  chlorazene. 

After  coitus  has  occurred  and  time  has  been  given  for  the 
spermatozoa  to  pass  out  of  the  vagina  and  through  the  cer- 
vical canal  on  their  way  to  the  oviducts,  the  vagina  should 
be  douched  in  order  to  overcome  the  irritation  of  coitus.  It 
has  already  been  stated  that  this  irritation  is  very  profound 
and  causes  a  tremendous  increase  in  the  number  of  nodules, 
in  the  inflammation  of  the  mucosa,  and  in  the  amount  of 


The  Nodular  Venereal  Disease  315 

muco-pus  present,  so  that  the  vulva  of  the  heifer  presents 
an  appearance  which  shows  very  definitely  the  fact  that  she 
has  copulated.  By  timely  douching,  this  irritation  and  ex- 
plosion of  the  infection  may  be  obviated.  It  is  quite  safe  to 
douche  within  four  or  five  hours  after  coitus.  The  evil  ef- 
fects of  coitus  may  be  controlled  by  douching  at  any  time 
after  the  period  named  up  to  about  twenty-four  hours.  The 
control  may  be  rendered  more  complete  by  repeating  the 
douche  at  intervals  of  twenty-four  hours  for  three  or  four 
times.  It  may  then  be  omitted.  The  control  of  the  disease 
at  any  period  in  the  sexual  life  of  the  animal  may  be  brought 
about  in  a  similar  manner.  Whenever  the  irritation  is 
marked,  the  vagina  may  be  douched  with  a  very  mild  anti- 
septic two  or  three  times  a  week,  and  such  douching  may  be 
continued  indefinitely.  There  is  an  old  prejudice,  sometimes 
still  revived,  against  douching  the  vagina  for  fear  of  causing 
abortion.  No  reason  exists,  so  far  as  I  know,  why  such  re- 
sult should  follow  a  vaginal  douche.  Clinically  I  have  seen 
no  tendency  whatever  for  the  douching  to  produce  any  ill 
effects.  It  is  a  valuable  hygienic  and  economic  measure, 
when  properlly  carried  out,  especially  upon  cows  which  are 
constantly  confined  in  the  stable.  While  douching  the  va- 
gina, the  operator  also  washes  the  exterior  of  the  vulva  and 
keeps  the  parts  clean. 

In  douching  the  vaginae  of  cows,  one  must  take  care  not 
to  transmit  from  one  to  another  some  important  form  of  in- 
fection. Under  proper  precautions  as  to  cleanliness,  no  such 
danger  ordinarily  exists.  Since  the  infections  in  a  given 
herd  are  fairly  uniform,  there  is  very  little  danger  that  one 
female  has  a  more  serious  genital  infection  than  her  neigh- 
bor. There  are,  however,  important  exceptions.  In  a  herd 
where  tuberculosis  exists  and  an  animal  chances  to  have 
genital  tuberculosis,  douching  her  vagina  and  then  the  va- 
ginae of  other  females  without  thoroughly  disinfecting 
would  be  highly  perilous.  However,  as,  under  proper  veteri- 
nary supervision,  no  cow  with  genital  tuberculosis  should 
exist  in  the  herd,  such  an  exposure  is  unjustifiable.  The 
same  conditions  apply  to  the  vesicular  venereal   disease. 


3 1 6  Diseases  of  the  Genital  Organs 

which  has  been  described  previously.  Careless  douching 
would  spread  this  infection  rapidly  throughout  the  entire 
herd.  As  with  tuberculosis,  this  is  wholly  unjustified,  be- 
cause the  animal  with  vesicular  venereal  disease  should  be 
in  strict  quarantine. 

Perhaps  the  greatest  danger  involved  in  the  general 
douching  of  a  herd  is  from  those  animals  which  may  have  a 
very  virulent  infection  of  the  genital  organs,  as  retained 
afterbirth  or  pyometra.  Here  again  the  prudent  veteri- 
narian places  the  seriously  infected  animal  under  efficient 
quarantine  and  before  an  apparatus  is  used  for  douching 
virtually  sound  animals,  except  for  moderate  nodular  vene- 
real disease,  it  is  to  be  thoroughly  disinfected  by  boiling. 

The  best  method  for  douching  the  vagina  and  washing 
the  exterior  of  the  vulva  is  by  means  of  a  gravity  apparatus 
suspended  from  an  elevated  track  behind  the  row  of  cows. 
Depending  upon  the  size  of  the  herd  and  the  surroundings, 
one  may  use  a  five-gallon  pail  with  a  faucet  or  a  barrel  of 
the  most  convenient  size,  attaching  to  it  a  soft  rubber  horse 
stomach  tube.  The  vessel  is  filled  with  the  desired  solution 
and  elevated  upon  the  track  approximately  two  or  three 
feet  above  the  backs  of  the  cows,  the  tube  is  inserted  into 
the  vagina  for  a  sufficient  distance,  and  the  fluid  is  per- 
mitted to  flow  in  rapidly  until  the  vagina  fills  and  the  wall 
contracts  and  expels  the  fluid.  Before  inserting  the  tube 
into  the  vagina,  the  exterior  of  the  vulva  should  be  washed 
with  sufficient  care  to  avoid  dragging  any  large  particles  of 
dirt  into  the  vagina.  By  such  a  plan,  the  breeder  or  dairy- 
man has  it  in  his  power  to  mitigate  and  control  the  severity 
of  the  nodular  venereal  disease.  With  proper  equipment, 
the  application  of  these  hygienic  measures  is  neither  diffi- 
cult nor  expensive.  One  man  can  readily  douche  the  vagi- 
nae of  forty  to  sixty  cows  an  hour,  and  do  it  reasonably  well. 


CHAPTER  XIII 

NON- VENEREAL  INFECTIONS  WHICH  INVADE 

THE  GENITALIA 

1.    Genital  Actinomycosis 

Although  actinomycosis  may  invade  any  organ  in  the 
body,  it  rarely  involves  the  genital  system.  Apparently 
this  is  not  due  to  any  notable  resistance  of  the  genital  or- 
gans against  this  infection,  but  rather  to  the  comparative 
infrequency  of  exposure.  Actinomycosis  of  the  genital  or- 
gans of  cattle  does  occur,  possibly  with  greater  frequency 
than  recorded  diagnoses  would  indicate.  Clinically,  I  have 
observed  actinomycosis  of  the  prepuce,  sheath,  and  inguinal 
lymphatics  in  a  bull.  There  was  present  in  the  prepuce  an 
actinomycotic  mass  five  or  six  inches  in  diameter  and  in  the 
peripenial  and  inguinal  lymph  glands  several  actinomycotic 
masses.  One  instance  of  penial  actinomycosis  in  the  bull 
has  been  brought  to  my  attention,  in  which  there  was  upon 
the  glans  an  actinomycotic  tumor  about  one  inch  in  diame- 
ter. The  veterinarian  under  whose  observation  the  case  oc- 
curred very  naturally  diagnosed  penial  tuberculosis. 

I  have  seen  two  clinical  cases  of  genital  actinomycosis  in 
cows.  In  my  first  case  there  was  merely  the  history  of  ster- 
ility in  a  highly  valued  pedigreed  cow  regarding  which  a 
colleague  called  me  in  consultation.  There  were  extensive 
pelvic  adhesions,  with  indistinct  outlines  of  the  genitalia 
and  large,  indurated  abscesses  in  the  mesometrium.  Since 
the  animal  was  evidently  incurable,  she  was  slaughtered. 
Autopsy  revealed  several  sclerotic  abscesses,  three  to  four 
inches  in  diameter,  located  in  the  mesometrium,  with  other 
abscesses  in  the  liver.  Histologic  search  showed  that  the 
abscesses  were  actinomycotic  in  origin.  No  definite  avenue 
of  invasion  was  determined. 

My  second  case  of  genital  actinomycosis  was  in  a  cow  that 
had  calved  and  had  suffered  from  retained  placenta.  I  at- 
tended her  and  removed  the  placenta  manually.  Apparently 
she  did  well  for  a  time  but  after  a  few  months,  as  she  failed 
to  breed  or  to  show  estrum,  she  was  again  examined.     I 


3i8 

r 


Diseases  of  the  Genital  Organs 


t^.!^' 


Pi,;   92— Genital  Actinomycosis.     Cow. 

Above,  dorsal  view  of  Kt-'nito-^rinary  trad  shouin-  irre-uhu  vwUx^^v- 
nienl  and  extensive  pelvic  adhesions;  below,  median  lon-ilndinal  >riUon 
through  Kenilo-urinary  tract.  /,  VaRina  ;  J.  os  nlen  exlernuni  ;  .,',  base  ot 
left  nterine  horn  ;  ./,  apex  do;  5.  actinomycotic  ntenne  body;  6,  actino- 
mycotic abscesses  in  nterine  horns  ;  7.  .V,  cross  .sections  of  actinomyootic 
ovidncts;  9,  actinonivcotic  ab.scess  in  ovary;  /<>,  corpns  Uileinu  (\.ir. 
nigrum)  ;  //,  //,  actinomycotic  invasion  of  urinary  bladder. 


Non-  Venereal  Infections  ivhich  Invade  the  Genitalia        319 

found  complete  pelvic  adhesions  and  a  greatly  enlarged 
sclerotic,  and  irregular  uterus.  I  diagnosed  tuberculosis 
and  advised  immediate  slaughter.  Inspection  revealed  that 
the  disease  was  confined  wholly  to  the  genito-urinary  organs 
and  that  the  lesions  were  actinomycotic.  The  general  ap- 
pearances are  illustrated  in  Fig.  92. 

Accurate  clinical  diagnosis  of  genital  actinomycosis  is  dif- 
ficult. Sometimes  it  closely  simulates  tuberculosis.  Here  the 
tuberculin  test  may  greatly  aid,  but  tuberculosis  may  exist 
in  other  organs  and  cause  a  reaction  although  the  genital 
disease  is  actinomycotic.  In  some  advanced  cases  of  tuber- 
culosis with  involvement  of  the  genitalia,  tuberculin  causes 
no  reaction.  There  occur  also  in  sclerotic  metritis  due  to 
common  pyogenic  invasions  pelvic  adhesions  with  abscesses 
closely  resembling  genital  actinomycosis.  Ordinarily  an 
accurate  clinical  diagnosis  as  to  species  of  infection  is  not 
demanded.  The  lesions  render  the  case  hopeless  and  dic- 
tate slaughter.  Then  should  follow  accurate  post-mortem 
diagnosis,  in  the  interest  of  contact  animals. 

Rarely  the  disease  may  be  amenable  to  treatment,  but  for 
this  purpose  needs  to  be  diagnosed  early  and  surgical  and 
medicinal  interference  promptly  put  into  effect  according 
to  the  general  plan  for  handling  actinomycosis  of  other  or- 
gans :  the  seriously  diseased  tissues  should  be  surgically  re- 
moved and  potassium  iodide  administered  internally.  When 
the  disease  involves  the  glans  penis  of  the  bull,  the  affected 
part  may  be  successfully  amputated,  as  described  for  ma- 
lignant neoplasms  of  the  penis. 

2.    Genital  Tuberculosis 

Tuberculosis  of  the  genitalia  of  cattle  has  generally  been 
considered  as  rare  and  of  scant  scientific  and  economic  im- 
portance. William  Williams^  states,  "If  the  cow  be  in  calf, 
abortion  is  apt  to  occur;  if  not  pregnant,  the  condition 
called  nymphomania  is  frequently  present."  Law-  states, 
"The  generative  organs  also  occasionally  suffer  (from  tu- 

'  Principles  and  Practice  of  Veterinary  Medicine,  1875,  p.  347. 
2  Vet.  Med.,  Vol.  IV,  1902,  pp.  448,  449. 


320 


Diseases  of  the  Genital  Organs 


berculosis),  in  which  case  an  early  and  rather  persistent 
symptom  is  steriHty,  with  a  too  frequent,  or  it  may  be  per- 
sistent desire  for  the  bull  (nymphomania).  *  *  *  In 
cases  of  uterine  tuberculosis,  the  nymphomania  may  be 
supplemented  by  a  purulent  discharge.  *  *  *  Genital 
tuberculosis  in  the  bull  is  associated  with  nodular  swelling 
of  the  testicle,  epididymis,  or  cord,  hydrocele,  and  excep- 
tionally tubercle  on  the  penis  or  in  the  prostatic  sac." 
Friedberger  und  Frohner^  state  that  genital  tuberculosis 
occurs  rarely  in  both  sexes  and  may  invade  any  portion  of 
the  genital  system.  Hutyra  und  Marek-  mention  the  occur- 
rence of  tuberculous  epididymitis  and  orchitis,  sometimes 
accompanied  by  tuberculous  abscessation  of  the  testis,  with 
a  consequent  fistula.  They  consider  penial  tuberculosis  as 
extremely  rare,  and  claim  that  when  it  occurs  the  glans 
penis  becomes  studded  over  with  tubercles.  Quoting  Hess, 
they  regard  uterine  and  tubal  tuberculosis  as  rare  and  as 
causing  sterility  and  nymphomania.  Vulvo-vaginal  tuber- 
culosis is  mentioned  as  a  rare  possibility.  Hoare  describes 
genital  tuberculosis  very  briefly,  without  according  it  an 
important  place.  He  admits  the  possibility  of  transmission 
by  copulation.  He  mentions  a  single  case  of  primary  penial 
tuberculosis. 

Most  veterinary  literature  concerning  genital  tuberculo- 
sis is  in  sharp  contrast  with  my  personal  observations.  The 
difference  in  view  is  possibly  due  to  a  variation  in  the  di- 
rection of  study.  Veterinarians  rarely  look  for  genital  tu- 
berculosis, since  ordinarily  it  does  not  aff"ect  the  general 
well-being  of  the  patient.  Clinically,  it  is  only  when  one 
concentrates  his  observations  upon  the  diseases  of  the  geni- 
tal organs  in  connection  with  sterility  that  he  recognizes 
genital  tuberculosis  and  realizes  its  importance.  The  geni- 
talia are  not  inspected  frequently  in  the  abattoir.  They  are 
not  used  as  human  food.  When  they  are  tuberculous,  the 
lesions  possess  little  or  no  importance  in   relation   to  the 

'  Specit'llen  Patholo.uic  und  Therapii-. 

^Spcv.iellL'  Palholojijie  und  Therai)i(.'  iUt  Hausticiv. 

^vSysteni  of  Veterinary  Medicine. 


Non-  Venereal  Infections  ichicli  Invade  the  Genitalia       321 

value  of  other  tissues  for  food.  Hence,  much  genital  tuber- 
culosis may  pass  unnoted. 

The  genital  mucosa  offers  a  highly  vulnerable  field  for 
tuberculous  invasion,  but  genital  exposure  to  tuberculosis 
is  rare  as  compared  with  exposure  through  contaminated 
food.  That  is,  when  open  pulmonary  tuberculosis  exists, 
the  patient  is  constantly  contaminating  mangers,  food,  and 
water  by  means  of  her  sputum,  so  that  companions  are  ex- 
posed daily  and  hourly.  When  genital  tuberculosis  exists, 
the  exposure  may  be  identical,  because  of  the  genital  dis- 
charges contaminating  food  and  water,  but  the  special  ve- 
nereal exposure  occurs  only  during  the  very  brief  period  of 
copulation. 

I  have  not  observed  tuberculous  orchitis  or  epididymitis. 
There  is  no  example  of  either  in  my  pathologic  collection  of 
genitalia,  and  no  specimen  in  the  collection  of  any  depart- 
ment of  the  college.  The  scattered  records  in  veterinary 
literature  of  tuberculous  orchitis  and  epididymitis  do  not 
serve  as  a  very  accurate  basis  for  outlining  the  clinical 
symptoms.  In  a  general  way,  it  is  stated  that  the  epididymis 
and  testes  show  painless  enlargement  and  hardening.  The 
demarcation  between  the  epididymis  and  the  testis  gradu- 
ally becomes  clouded,  and  finally  is  lost.  Apparently  the 
epididymis  usually  becomes  involved  first,  and  the  disease 
extends  thence  to  the  gland.  The  tuberculous  process  is 
said  to  be  located  usually  in  the  parenchyma,  having  its 
basis  in  the  mucosa  of  the  epididymis  and  testis.  In  this 
manner  the  disease  may  be  well  advanced  before  peripheral 
inflammation  or  tuberculous  extension  involves  the  peri- 
toneal coverings,  to  cause  adhesions  and  hydrocele.  Rarely, 
abscessation  is  said  to  ensue,  resulting  in  a  fistula. 

The  clinical  diagnosis  of  tuberculous  epididymitis  and 
orchitis  is  difficult.  Painless  tumefaction  of  the  testis  is  not 
characteristic  of  tuberculosis,  but  may  ensue  from  various 
pyogenic  infections.  Peritoneal  adhesions,  hydrocele,  and 
abscessation  are  quite  as  probable,  if  not  more  so,  from  other 
infections  than  from  tuberculosis.  Next  to  the  excision  of 
the  testis  and  its  examination,  tuberculin  offers  the  best 


322  Diseases  of  the  Genital  Organs 

means  for  diagnosis.  As  is  well  known,  tuberculin  has  its 
limitations,  and  may  fail.  If  the  patient  responds  to  tuber- 
culin, the  evidence  of  tuberculous  epididymitis  or  orchitis 
is  not  complete.  There  may  be  tuberculous  lesions  in  other 
organs,  causing  the  response  to  tuberculin,  while  the  lesions 
in  the  epididymis  and  testis  may  be  non-tuberculous.  When 
but  one  testicle  is  involved,  its  removal  and  histo-biologic  ex- 
amination offers  by  far  the  most  reliable  means  for  diag- 
nosis. If  the  disease  has  existed  for  some  time,  the  re- 
moval of  the  testis  is  in  no  case  an  economic  waste,  because 
as  a  general  rule  chronic  epididymitis  or  orchitis  signifies 
permanent  loss  of  function  of  the  involved  gland.  Its  re- 
moval is  the  best  curative  measure  and  the  greatest  avail- 
able protection  for  the  other  testicle  and  for  the  breeding 
life  of  the  bull. 

The  path  of  tuberculous  invasion  of  the  epididymis  and 
testis  has  not  been  clearly  learned.  The  infection  is  not 
primary.  It  does  not  seem  to  be  secondary  to  penial  infec- 
tion. While  I  have  observed  several  cases  of  primary  penial 
tuberculosis,  I  have  not  noted  subsequent  tuberculous  epidi- 
dymitis or  orchitis.  It  appears  highly  improbable  that  the 
tubercle  bacilli  would  traverse  the  long  urethra  and  vas 
deferens  and  reach  the  epididymis  without  leaving  behind 
evidences  of  its  passage  in  the  form  of  penial  or  urethral 
tuberculosis.  When  the  infection  is  wholly  within  the  tu- 
bules of  the  epidymis  or  testis,  as  appears  usually  to  be  the 
case,  the  invasion  is  apparently  not  direct  from  the  perito- 
neum. When  the  scrotal  peritoneum  is  first  involved,  it 
would  appear  probable  that  the  invasion  occurred  from  the 
peritoneal  cavity  through  the  open  inguinal  ring.  Appar- 
ently most  instances  of  tuberculous  epididymitis  and  or- 
chitis are  referable  to  hematogenic  sources  and  constitute  a 
part  of  generalized  tuberculosis. 

The  prognosis  for  the  involved  gland  is  hopeless.  If  only 
one  gland  is  involved,  it  may  be  successfully  removed,  leav- 
ing the  bull  perfectly  fertile.  The  difficulty  is  that,  since 
the  tuberculous  epididymitis  or  orchitis  is  usually  a  second- 
ary rather  than  a  primary  lesion,  the  basic  lesion  remains 


Non-  Venereal  Infections  zchich  Invade  the  Genitalia        323 

and  probably  unfits  the  bull  for  breeding  except  when  mated 
with  infected  cows  held  under  the  Bang  plan.  Even  in  such 
cases,  it  needs  to  be  determined  that  the  vas  deferens,  vesi- 
culae  seminales,  prostate  gland,  and  penis  are  free,  or  the 
bull  becomes  a  serious  menace  even  to  tuberculous  cows,  be- 
cause when  such  parts  are  involved  tubercle  bacilli  may  be 


Fig.  93— Tuberculosis  of  Sheath  and  Prepuce  of  Bull. 

S,  Sheath  ;   U,  urethra  ;  6",  glans  ;  F,  fornix  ;  CC,   corpus  cavernosum, 
/,  /,  fissure  extending  into  tubercular  mass. 

ejaculated  with  the  semen  from  the  sound  testicle,  inducing 
primary  genital  (venereal)  tuberculosis  in  the  cow,  which 
may  promptly  bring  her  breeding  life  to  a  close. 

Tuberculosis  of  the  vas  deferens,  seminal  vesicle,  and 
prostate  is  possible,  but  apparently  too  rare  to  be  of  great 


324  Diseases  of  the  Geniial  Organs 

economic  importance.  Tuberculosis  of  the  vesiculae  semi- 
nales  or  prostate  would  tend  to  interfere  with  urination  and 
copulation  (ejaculation).  The  diagnosis  of  tuberculosis  of 
these  parts  would  be  based  necessarily  upon  rectal  palpation. 

Penial  Tuberculosis.  Penial  tuberculosis  is  comparatively 
common  in  the  bull.  The  corpus  cavernosum,  urethra,  and 
urethral  mucosa  are  not  involved  as  frequently  as  the  sub- 
mucosa  of  the  glans,  prepuce  and  sheath,  and  the  adjacent 
penial  lymphatics. 

Tuberculosis  invades  any  organ  far  more  readily  when 
the  protective  epithelium  is  wounded.  The  anatomy  of  the 
copulatory  apparatus  of  the  bull  and  the  mechanism  of  copu- 
lation render  epithelial  injuries  more  probable  elsewhere 
than  in  the  mucosa  of  the  glans  penis  itself.  The  penis  of 
the  bull  (and  of  ruminants  generally)  is  very  firm.  The 
transverse  diameter  and  the  rigidity  of  the  penis  are  but 
slightly  modified  by  erection.  The  protrusion  of  the  penis 
during  copulation  is  brought  about  almost  wholly  by  the 
elimination  of  the  sigmoid  flexure  (See  Fig.  99),  the  ac- 
complishment of  which  requires  the  relaxation  of  the  re- 
tractor penis  muscle.  When  at  rest,  the  penis  lies  within 
the  prepuce,  above  the  sheath.  As  a  rule,  no  distinction  is 
drawn  between  the  mucosa  of  the  sheath  and  that  of  the 
prepuce,  although  they  have  a  wholly  different  embryologic 
history.  The  sheath  exists  as  a  distinct  structure  at  the 
time  of  birth;  the  prepuce  does  not.  In  the  new-born  rumi- 
nant and  porcine  male,  the  sheath  constitutes  a  compara- 
tively short  infundibulum,  terminating  at  the  bottom  in  the 
meatus  urinarius  (Fig.  8,  page  14,  and  Fig.  9,  page  15). 
No  part  of  the  glans  penis  is  exposed.  At  the  time  of  birth, 
the  two  layers  of  mucosa,  one  of  which  is  later  to  form  the 
mucosa  of  the  glans  penis  and  the  other  the  mucous  mem- 
brane of  the  prepuce,  are  firmly  adherent  to  each  other. 
Later,  when  sexual  maturity  approaches,  the  tissue  between 
the  two  layers  of  mucous  membrane,  which  serves  to  bind 
them  together,  slowly  gives  way,  and  the  preputial  sac 
finally  becomes  established.  In  the  abattoir,  one  may  ob- 
serve in  veal  calves  every  gradation  of  fho  do volopmont  of 


No7i-  Ve7ieyeal  Infections  ivhich  Invade  the  Genitalia       325 

the  prepuce.  The  gradations  may  be  seen  also  in  castrated 
males  (Fig.  9a,  page  16).  The  preputial  sac  may  be  totally 
absent,  or  there  may  be  any  degree  of  development,  accord- 
ing to  the  stage  of  sexual  development  at  the  time  of  castra- 
tion. The  anatomy  and  the  mode  of  protruding  the  penis 
during  coitus  have  been  described  on  page  14.     The  coital 


\    ^ 

U 

.-*;: 

CC       R                 G 

Fig.  94— Rupture  of  Prepuce  From  Coital  Violence. 

CC,  Corpus   cavernosum  :    F,  fornix  ;    P,  prepuce  ;    6",  glans  ;    U,  urethra  ; 

R,   coital  rupture.     At  the  right  end  of  the  rupture  the  ruptured 

border  of  the  prepuce  is  folded  upon  itself. 

thrust  of  the  bull  is  vigorous,  or  sometimes  so  violent  that 
the  prepuce  is  torn  or  ruptured,  as  shown  in  Figs.  61  and  94. 
The  abraded  or  ruptured  portion  is  withdrav^n  at  once,  v^ith 
the  retraction  of  the  penis,  and  any  infection  which  has  en- 
tered the  wound  is  carried  along. 


Fig.  95— Tuberculosis  of  Glans  and  Prepuce. 

G,  Glans  ;  P,  prepuce  ;   /%   fornix  ;   U,   urethra  ;  CC,  corpus 
cavernosum  ;    Tb,  tubercle  in  tip  of  glans  ;  A,  tuber- 
cular abscess  in  prepuce. 


326  Diseases  of  the  Genital  Organs 

The  superficial  genital  mucosa  of  the  bull,  as  well  as  that 
of  the  ram  and  the  boar,  is  further  exposed  to  abrasions  and 
consequent  infection  by  the  presence  of  the  granules  or 
nodules  of  the  granular  venereal  disease — a  chronic  infec- 
tion which  is  essentially  universal.  The  granules  or  nodules 
frequently  become  inflamed,  especially  from  excessive  coitus, 
the  epithelium  at  the  summits  of  the  granules  becomes 
abraded,  and  hemorrhage  ensues.  It  is  not  rare  to  see  the 
granular  venereal  disease  so  severe  that  the  parts  bleed 
after  each  coitus,  if  the  bull  will  copulate.  Sometimes  the 
pain  is  so  great  that  he  refuses  to  copulate;  sometimes  the 
swelling  of  the  sheath  is  so  great  that  the  penis  can  not  be 
protruded — the  bull  has  phimosis. 

Therefore,  in  addition  to  the  very  delicate  epithelium  of 
the  genital  mucosa,  the  prepuce  itself  may  be  ruptured,  or 
a  multitude  of  minute  abrasions  may  occur  at  the  summits 
of  the  granules  regularly  present.  These  abrasions  off"er 
special  facility  for  invasion  by  pathogenic  bacteria.  If  the 
cow  is  afflicted  with  tuberculous  genital  catarrh,  any  abra- 
sions existing  upon  the  penis,  prepuce,  or  sheath  of  the  bull, 
or  occurring  at  the  time  of  copulation,  invite  tuberculous 
infection.  The  entire  group  of  such  tuberculous  infections 
may  be  classed  as  primary  venereal  or  coital  tuberculosis. 
Primary  tuberculosis  of  the  copulatory  organs  of  the  bull 
may  involve  any  tissue  or  part  contributing  to  the  copula- 
tory apparatus.     The  principal  types  I  have  observed  are : 

(1)  Tuberculosis  of  the  glans  penis, 

(2)  Sheath  tuberculosis, 

(3)  Preputial  tuberculosis, 

(4)  Tuberculosis  of  the  penial  lymph  glands. 

(1)  Tuberculosis  of  the  glans  penis  is  not  very  rare.  I 
have  observed  two  cases  clinically,  and  others  in  the  abat- 
toir. One  clinical  case  was  in  a  large  Holstein  herd  bull. 
For  some  months,  he  had  been  unable  to  copulate  with  small 
or  medium-sized  cows,  but  could  do  so  successfully  with 
large  cows  with  commodious  vulvae.  Attempts  at  copula- 
tion were  generally  followed  by  a  limited  amount  of  hemor- 
rhage.   The  glans  penis  was  enlarged,  especially  at  its  apex. 


Non-  Venereal  Infections  which  Invade  the  Genitalia 


327 


IT  a 


PL,    c« 


328  Diseases  of  the  Genital  Organs 

The  surface  was  dark-colored,  congested,  somewhat  eroded, 
and  suppurating  slightly.  Inability  to  copulate  was  appar- 
ently referable  to  the  combination  of  four  factors — the  en- 
largement of  the  glans;  the  roughening  of  its  surface,  due 
chiefly  to  the  destruction  of  the  epithelium,  thus  hindering 
the  introduction  of  the  glans  into  the  vulva ;  the  pain ;  and 
the  flaccidity  of  the  diseased  area.  The  penis  was  protruded 
readily.  When  the  bull  was  confined  upon  the  operating 
table,  the  penis  could  be  pushed  out  of  the  sheath  and  pre- 
puce by  forcibly  effacing  the  sigmoid  flexure.  When  thus 
forced  out  and  securely  grasped  so  that  the  part  could  be 
closely  inspected,  it  was  seen  that  the  apex  of  the  glans  for 
a  distance  of  about  3  inches  was  much  inflamed  and  en- 
larged, and  bled  readily  upon  touch.  The  diseased  tip  was 
dark  livid,  the  epithelium  largely  destroyed,  and  the  surface 
contaminated  by  purulent  exudate.  The  appearances  were 
strongly  suggestive  of  tuberculosis.  The  diseased  tip  of  the 
glans  was  amputated.  The  histologic  appearances  were 
those  of  tuberculous  lesions,  and  stained  smears  showed 
tubercle  bacilli.  The  operative  wound  progressed  very  fav- 
orably for  a  time,  and  the  bull  was  promptly  discharged 
from  the  clinic,  apparently  on  the  safe  road  to  recovery. 

The  patient  belonged  to  a  breeder  devoid  of  serious  regard 
for  the  control  of  tuberculosis.  It  was  understood  that  the 
disease  was  rampant  in  his  herd  and  that  he  was  more  con- 
cerned about  concealment  than  about  control.  I  was  unable 
to  follow  the  case.  Apparently  the  patient,  valived  at  about 
ten  thousand  dollars,  had  contracted  the  infection  by  copu- 
lating with  a  cow  having  genital  tuberculosis.  After  becom- 
ing infected,  he  was  evidently  a  very  serious  menace  to  any 
healthy  cow  with  which  he  might  copulate.  The  venereal 
peril  was  limited  chiefly  by  the  fact  already  related,  that  he 
could  not  copulate  with  most  cows  and  heifers,  but  only  with 
those  having  commodious  vulvae.  The  attitude  of  the  owner 
prevented  any  investigation  of  the  herd  in  an  effort  to  learn 
whether  any  harm  had  come  to  cows  from  coinilation  with 
this  animal.  So  far  as  I  have  observed,  he  was  one  of  the 
most  dangerous  bulls  I  have  seen  with  genital  tuberculosis, 


Noil-  Vencj'cal  Infections  ichich  Invade  the  Genitalia        329 

because  in  most  cases  copulation  is  promptly  and  absolutely 
excluded  and  venereal  transmission  thereby  avoided. 

A  very  interesting  abattoir  specimen  is  illustrated  in 
Fig.  61,  in  which  there  has  been  a  rupture  of  the  prepuce 
and  also  tubercular  infection  at  the  tip  of  the  glans  penis. 
The  rupture  of  the  prepuce  probably  furnished  the  avenue 
for  the  tuberculous  invasion. 

Tuberculosis  of  the  submucosa  of  the  glans  is  illustrated 
in  Fig.  96.  This  specimen  shows  numerous  tubercles  in 
the  submucosa.  They  were  not  recognizable  clinically.  The 
disease  was  brought  to  a  crisis  by  the  larger  tuberculous 
abscesses  in  the  prepuce  and  about  the  base  of  the  glans, 
which  rendered  protrusion  of  the  penis  impossible. 

(2)  Tuberculosis  of  the  penial  sheath  is  presumably  rare. 
In  my  collection  I  have  but  one  well  defined  specimen.  It 
was  obtained  from  the  abattoir  and  is  without  clinical  his- 
tory. Fig.  93  indicates  that  penial  incarceration  occurred 
early,  rendering  the  animal  impotent  and  causing  him  to 
be  sent  to  the  shambles.  Clinically,  the  condition  could  not 
well  have  been  differentiated,  upon  ordinary  examination, 
from  other  infections  of  the  sheath  wall,  especially  actino- 
mycosis. Amongst  chronic  infections,  however,  tuberculo- 
sis is  by  far  the  most  probable,  and  a  provisional  diagnosis 
of  tuberculosis  should  be  made.  The  tuberculin  test  may 
serve  as  an  aid,  but  is  subject  to  severe  limitations.  If  it  is 
reasonably  certain  that  the  bull  was  tubercle-free  prior  to 
the  development  of  the  lesion,  the  test  possesses  great  value. 
Exploratory  incision  through  the  external  skin,  and  the  re- 
moval of  material  for  bacterial  and  inoculation  studies,  is 
of  great  diagnostic  value. 

So  long  as  the  bull  can  protrude  the  penis  and  copulate, 
he  constitutes  a  serious  menace.  Since  the  infection  is  pri- 
mary, and  the  fundamental  lesion  in  the  mucosa  is  natu- 
rally open,  any  tuberculous  excretions  occur  within  the 
sheath.  The  glans  penis  inevitably  becomes  contaminated, 
but  not  necessarily  infected.  In  copulation,  however,  the 
surface  contamination  is  carried  into  the  vulva  and  vagina 
of  the  female.     In  protruding  the  penis,  as  will  be  under- 


330 


Diseases  of  the  Genital  Organs 


stood  by  studying  Figures  10,  page  17,  and  11,  page  18, 
until  the  swelling  becomes  too  great  for  copulation  to  occur, 
the  sheath  mucosa  is  reflected,  and  when  the  penis  is  fully 
protruded  the  tuberculous  membrane  itself,  constituting  the 
covering  of  the  penial  base,  enters  the  vulva  of  the  cow  dur- 
ing coitus. 


Fig.  97— Tuberculosis  of  the  Glans  and  Prepuce. 
P,  Prepuce  ;  t\  fornix  ;    Tl\  tubercular  masses. 

Accordingly  it  is  essential  that  great  care  be  exercised  in 
making  a  diagnosis  when  inflammatory  conditions  of  the 
sheath  exist,  and  that  every  available  means  be  taken  to 
eliminate  the  question  of  tuberculous  infection.  However, 
one  must  not  carelessly  incise  the  sheath  deeply,  for  diag- 
nostic or  other  reasons,  lest  the  resultant  cicatrix  incarcer- 
ate the  penis.  If  tuberculosis  is  diagnosed,  the  bull  should 
be  excluded  from  service,  even  to  reacting  cows,  and 
promptly  sent  to  slaughter. 

(3)    Preputial   tuberculosis    is    apparently    less    common 


Non-  Venereal  Infections  which  Invade  tJie  Genitalia       331 

than  tuberculosis  of  the  glans  or  of  the  sheath.  The  prepu- 
tial membrane,  which  is  far  more  delicate  than  that  of  the 
sheath,  is  exposed  during  copulation  to  special  injury  at 
the  base  of  the  glans.  At  this  point  the  epithelium  of  the 
glans  becomes  reflected,  to  constitute  the  lining  epithelium 
of  the  preputial  sac.  At  the  moment  of  the  copulatory 
thrust,  the  parietal,  or  outer  preputial  membrane  is  sud- 
denly and  violently  reversed,  to  constitute  the  covering  of 
the  penis  from  the  base  of  the  glans  backwards  for  a  dis- 
tance approximately  equal  to  the  length  of  the  glans  itself. 
Further  back,  the  sheath  mucous  membrane  succeeds  the 
prepuce  as  the  mucous  covering  of  the  protruded  penial 
body.  The  prepuce  and  the  sheath  mucosa  become  completely 
reversed.  That  end  of  the  sheath  mucosa  which,  while  the 
penis  was  at  rest,  was  situated  most  anteriorly  now  be- 
comes most  posterior.  The  mucosa  of  the  sheath  and  of  the 
prepuce  become  reversed  in  relation  to  each  other.  When 
the  penis  is  at  rest,  the  prepuce  is  behind  the  sheath,  but 
when  the  penis  is  protruded  the  prepuce  is  in  front  of  the 
reversed  sheath  mucosa.  Accordingly  the  prepuce,  at  the 
point  of  its  attachment  to  the  base  of  the  glans,  is  one  of 
the  most  vulnerable  areas  at  which  tuberculosis  and  other 
infections  may  effect  an  entrance.  When  infection  occurs, 
it  usually  leaves  scant  trace  in  the  epithelium  of  the  glans, 
but  involves  chiefly  the  lymph  glands  of  the  submucosa. 

As  soon  as  infection  occurs  and  inflammation  is  estab- 
lished, the  loose  areolar  tissue  between  the  prepuce  and  the 
external  dartoid  sheath  becomes  involved,  adhesions  occur, 
and  the  penis  is  incarcerated.  By  studying  Figures  8-11, 
pp.  14-18,  it  will  be  seen  that  as  soon  as  such  inflammatory 
adhesions  become  established  copulation  is  at  an  end,  be- 
cause the  preputial  wall  can  not  become  reflected  upon  the 
body  of  the  penis.  The  adhesion  of  the  outer  with  the  inner 
layer  at  the  base  of  the  glans  serves  to  hold  the  penis  firmly 
in  its  retracted  position. 

Clinically,  the  lesion  is  probably  not  usually  observed  un- 
til well  established.  That  is,  the  infection  probably  goes 
unobserved  even  though  several  copulations  are  made  dur- 


332 


Diseases  of  the  Genital  Organs 


Non-  Venereal  Infections  'ivhich  Invade  the  Genitalia        333 

ing  the  few  succeeding  days.  When  the  lesion  has  reached 
a  certain  development,  a  given  copulation,  especially  v^ith  a 
heifer,  irritating  the  lesion  severely,  sets  aflame  the  estab- 
lished infection.  Then  the  lesion  is  observed,  and  is  natu- 
rally attributed  to  mechanical  injury  referable  to  the  last 
copulation,  though  this  is  only  partly  true.  Then  swelling 
in  the  preputial  region  becomes  evident,  incarceration  of 
the  penis  follows  quickly,  and  copulation  can  no  longer  occur. 

The  diagnosis  is  fundamentally  dependent  upon  symp- 
toms essentially  identical  with  those  seen  in  sheath  tubercu- 
losis, except  that  the  lesion  is  located  further  backward, 
just  anterior  to  the  scrotum.  It  can  not  be  differentiated 
from  other  infections  by  an  ordinary  physical  examination. 
Before  a  technical  diagnosis  can  be  made,  it  is  essential  to 
include  the  tuberculin  test  and  bacterial  search.  In  a  breed- 
ing sense,  the  lesion  is  not  subject  to  cure. 

(4)  Tuberculosis  of  the  venial  lymph  glands  is  by  far  the 
most  commonly  observed  type  of  genital  tuberculosis  in 
bulls.  Apparently  entering  through  a  lesion,  either  recog- 
nizable or  unrecognizable,  of  the  glans,  sheath,  or  prepuce, 
it  may  involve  the  lymph  glands  at  any  point  from  the  mar- 
gin of  the  sheath,  along  the  prepuce,  and  up  to  and  above 
the  sigmoid  flexure.  Clinically,  in  opening  the  small  peri- 
penial  abscesses,  I  flnd  that  they  contain  thick  pus,  and  that 
the  abscess  walls  are  dark,  angry  red,  without  calcification. 
The  lymph  glands  lie  chiefly  along  the  sides  of  the  penis. 
When  involving  the  small  glands  outside  the  mucous  mem- 
branes of  the  sheath  and  prepuce,  the  inflammatory  adhe- 
sions soon  prevent  the  reflection  of  these  membranes  upon 
the  exterior  of  the  penis,  make  its  protrusion  impossible, 
and  exclude  copulation.  Swellings  in  the  region,  usually 
well  defined  and  painless,  are  evident.  Abscessation  gradu- 
ally develops,  but  the  abscesses  are  small  and  their  walls 
sclerotic,  non-fluctuant,  and  without  a  tendency  to  "point" 
or  break.  The  lesions  are  well  illustrated  in  Figures  96,  97, 
98  and  99. 

Sometimes  the  sigmoid  lymph  glands  are  involved,  while 
those  of  the  sheath  and  prepuce  are  slightly  or  not  at  all 


334  Diseases  of  the  Geyiital  Organs 

affected.  In  such  cases,  as  shown  in  Figures  98  and  99,  the 
chief  clinical  phenomenon  is  inability  to  protrude  the  penis 
and  copulate.  The  inflamed  glands  induce  adhesions  which 
inhibit  the  elimination  of  the  sigmoid  flexure.  Palpation 
of  the  region  readily  enables  the  veterinarian  to  detect  the 
enlarged  glands. 

The  enlargement  of  the  lymph  glands  of  the  sheath,  pre- 
puce, or  sigmoid  flexure  constitutes  strong  evidence  of  pri- 
mary venereal  tuberculosis.  Other  infections  may  induce 
similar  adenitis,  but  commonly  the  veterinarian  is  justified 
in  provisionally  diagnosing  such  lesions  as  tuberculosis.  He 
may,  should  circumstances  demand,  search  for  bacterial  or 
other  evidence.  On  the  whole,  any  chronic  adenitis  of  these 
glands  ruins  the  breeding  value  of  the  bull  and  dictates 
slaughter.  A  positive  diagnosis  is  highly  important,  even 
when  made  post  mortem.  If  it  is  tuberculosis — and  that  is 
the  rule — there  must  be  highly  dangerous  cows  in  the  herd, 
the  genitalia  of  which  should  be  subjected  to  very  rigid 
search  for  tuberculosis.  While  a  bull  may  become  infected 
in  copulating  with  a  cow  when  the  exterior  of  the  vulva  is 
contaminated  with  tubercle-bearing  fecal  excreta,  this  is 
improbable.  The  assumption  should  generally  be  that  the 
infection  has  arisen  from  copulating  with  a  female  having 
tuberculous  genital  catarrh.  Such  an  offender  should  be 
detected  and  eliminated.  She  is  almost  always  incurably 
sterile.  She  constitutes  a  great  peril  to  any  breeding  sire, 
and  is  one  of  the  worst  "spreaders"  of  tuberculous  infection. 

Tuberculosis  of  the  Female  Genitalia 

Every  part  of  the  genital  organs  of  the  cow  is  subject  to 
invasion.  My  collection  contains  examples  of  ovarian,  tubal, 
uterine,  cervical,  and  vaginal  tuberculosis,  and  I  have  ob- 
served clinically  vulvar  tuberculosis. 

(1)  Ovarian  tuberculosis  is  very  rare,  but  is  far  more 
common  than  orchitic  tuberculosis.  The  ovary  is  more  ex- 
posed to  the  infection  than  the  testicle,  especially  in  the 
presence  of  extensive  peritoneal  lesions.  I  have  obtained 
but  two  good  examples.     One  of  these.  Fig.  100,  is  highly 


Tuberciclosis  of  the  Female  Ge?nialia  335 

interesting,  because  casual  examination  suggests  that  the 
avenue  of  invasion  of  the  ovary  was  through  the  physiologic 
lesion,  the  crater  of  a  ruptured  ovisac.  The  dense  invest- 
ing tunic  of  both  the  testis  and  the  ovary  appears  to  offer  a 
highly  effective  barrier  against  tuberculous  invasion,  with 
the  important  difference  that  in  the  ovary  there  occur  in- 
tervals (ovulation)  when  the  tunic  is  ruptured  and  its  con- 
tinuity temporarily  in  abeyance.    Viewed  in  this  light,  more 


3 

1 

Tb 

r''- 

V 

CI 

Fig.  100— Tuberculosis  of  Ovary  and  Oviduct. 

/,  Section  through  oviduct ;    2,  oviduct  thrown  into  coils  by  elongation ; 

J,  ovary  sliowing  a  corpus  luteum,   CI,  and  a  tubercular  mass, 

Tb,  in  crater  of  a  ruptured  ovisac. 

ovarian  than  orchitic  tuberculosis  might  be  expected.  Ap- 
parently this  is  true.  Nevertheless,  the  ovary  is  highly  re- 
sistant to  the  infection,  as  compared  with  other  portions  of 
the  female  genitalia.  Frequently  the  uterus  and  oviducts 
are  highly  tuberculous,  while  the  ovary  remains  normal.  In 
the  second  example  of  ovarian  tuberculosis  in  my  collection, 
shown  in  Fig.  101,  the  ovaries  and  oviducts  have  largely 
undergone  tuberculous  necrosis.  Generally,  when  the  ovi- 
ducts are  involved,  the  pavilion  is  adherent  to  the  ovary, 
and  the  peritoneal  side  of  the  pavilion  is  studded  over  with 


336 


Diseases  of  the  Genital  Organs 


Tuberculosis  of  the  Female  Geyiitalia  337 

tubercles,  as  shown  in  Figures  102,  103,  105  and  106,  but  the 
adherent,  encapsulated  gland  resists  invasion. 

Ovarian  tuberculosis  can  not,  in  my  experience,  be  directly 
and  positively  diagnosed  clinically.  Clinical  diagnosis  is  not 
highly  important,  since  ovarian  invasion  rarely,  if  ever,  oc- 
curs without  tubal  and  uterine  tuberculosis,  each  of  which 
is  open  to  reasonably  safe  clinical  diagnosis.  So  far  as  I 
am  aware,  ovarian  tuberculosis  induces  no  clinical  symp- 
toms. There  is  a  definite  impression  given  in  veterinary 
literature  that  ovarian  tuberculosis  sometimes  causes  ster- 
ility, but  there  is  no  evidence  submitted.  So  far  as  I  have 
seen,  it  is  the  coexisting  or  preexisting  tubal  and  uter- 
ine tuberculosis  which  causes  the  sterility.  Statements  oc- 
cur also  (Huytra  and  Marek,  Law)  that  genital  tuberculo- 
sis, either  through  the  invasion  of  the  ovaries  or  otherwise, 
induces  nymphomania.  No  evidence  is  submitted  upon  the 
point.  The  power  of  tuberculosis  of  any  portion  of  the 
genital  tract  to  cause  nymphomania  is  probably  pure  legend. 
A  careful  study  of  nymphomania  shows  it  to  be  due  to  a 
definite  type  of  cystic  degeneration  of  the  ovary,  wholly  de- 
void of  any  trace  of  relation  to  tuberculosis.  Genital  tuber- 
culosis and  the  nymphomaniacal  type  of  ovarian  cyst  may 
coexist,  but  that  is  not  evidence  of  either  identity  or  rela- 
tionship. 

(2)  Tubal  tuberculosis  is,  next  to  uterine  tuberculosis, 
the  commonest  type  observed  in  the  genitalia  of  cattle.  In 
many  specimens,  the  appearances  suggest  that  the  infection 
has  invaded  the  oviducts  centrifugally  from  the  peritoneal 
cavity  through  the  pavilion.  In  other  instances  of  even 
severe  uterine  tuberculosis,  the  oviducts  are  free.  Tuber- 
culous oviducts  are  usually  recognizable  by  rectal  palpation. 
They  become  enlarged  and  very  hard.  Generally  they  are 
adherent  and  studded  over  with  large  tubercles.  The  tuber- 
culous tubes  vary  in  transverse  diameter  up  to  0.5  inches  or 
over.  When  much  enlarged,  they  become  elongated  and 
thrown  into  folds  lying  in  front  of  and  lateral  to  the  ovary, 
as  shown  in  Figures  103-106  inclusive.    The  disease  may  be 


338 


Diseases  of  the  Genital  Orgai 


•y. 

.   ir. 

^  £  - 

fl   o  = 


>   =: 
O- 


s  :;  1- 


Ttiberadosis  of  the  Female  Genitalia 


339 


confused  with  ordinary  pyosalpinx  or  hydrosalpinx.  In 
ordinary  pyosalpinx,  there  are  two  types.  In  the  first  and 
commonest,  there  is  not  much  pus  and  the  oviducts  are  not 
greatly  enlarged,  but  are  very  firm  and  of  even  contour;  in 
the  second,  the  pus  is  voluminous  and  the  oviduct  walls  at- 
tenuated, giving  a  soft  fluctuating  tube,  with  thin,  atonic 


Fig.  103 — Tuberculosis  of  Ovary   and  Oviduct.. 
The  Oviducts  are  very  Nodular  and    Enlarged,  the  Ovary  Adherent 
in  the  Pavilion  and  Broad  Ligament.     Ov,  Oviduct  lying 
lateral  to  the  ovary  ;   C,  ovary  ;    UC,  uterine  cornu. 


lymph,  firm  and  fluctuant.  Tuberculous  salpingitis  is,  in 
my  experience,  always  nodular,  the  tubes  very  hard,  ad- 
herent, and  quite  large. 

walls.      In    hydrosalpinx,    the    oviduct    is    distended    with 
Tuberculosis  of  the  oviduct  is  almost,  if  not  always  bi- 


340 


Diseases  of  the  Genilal  Organs 


V 


I'K,      mi— Dorsal    Surface    of   Tuberculous    Oviducts,     Uterus 

Vagina,  Showing-  extensive  Pelvic  Adhesions  and  Adhesions  ot 

Ovaries  in  Pavilion  of  Oviduct  and  Broad  Ligament. 

O,  Ovary  ;  /  C,  uUriiu-  cornu  ;    (>:\  ovichict  uxtciuluii;   laterally 

to  the  ovarv  ;    T,  utmis  ;    / ',  v:i.>;iii:i. 


and 


Tuberculosis  of  the  Female  Genitalia  341 

lateral,  rendering  the  animal  incurably  sterile  as  well  as  a 
peril  in  a  breeding  or  milking  herd.  The  pus  from  tuber- 
culous pyosalpinx  escapes  through  the  uterus  and  cervix  to 
the  vagina,  to  constitute  a  very  serious  menace  to  the  bull. 
(3)  Uterine  tuberculosis  is  the  commonest  and  most  dan- 
gerous type  of  genital  tuberculosis.  It  is  supremely  dan- 
gerous to  the  bull  when  copulating  with  the  affected  animal. 
The  discharges  resulting  from  the  tuberculous  uterine  ca- 
tarrh soil  the  vulva,  tail,  thighs,  and  ultimately  the  udder, 
and  contaminate  the  milk.  Thus  the  milk  becomes  intensely 
dangerous  for  calves,  for  other  animals,  and  for  man.  In 
its  peril  to  animal  and  human  health,  uterine  tuberculosis 
vies  with  tuberculosis  of  any  other  organ.  Uterine  tuber- 
culosis is  quite  variable,  showing  three  somewhat  separable 
types : 

(a)  Peritoneal  uterine  tuberculosis  with  extensive  pelvic 
adhesions,  as  shown  in  Figures  104,  105,  106. 

(b)  Tuberculosis  of  the  glandular  structure  of  the  uterine 
mucosa,  as  shown  in  Figures  105,  106,  107,  108,  109. 

(c)  Tuberculosis  of  the  epithelial  layer  of  the  mucous 
membrane,  as  shown  in  Fig.  110. 

No  clear  line  of  demarcation  can  be  drawn  between  the 
three  types,  but  in  most  cases  one  of  the  three  groups  of 
lesions  predominates. 

In  uterine  tuberculosis  there  is  generally  a  persistent,  ob- 
stinate uterine  catarrh.  In  some  cases  the  catarrhal  dis- 
charge is  inconspicuous.  Douching  the  uterus  may  reveal 
very  little  pus.  In  some  cases  of  tuberculous  uterine  ca- 
tarrh, uterine  douches  affect  the  catarrh  favorably  for  a 
time,  but  permanent  relief  I  have  not  observed.  Where 
there  have  been  apparently  favorable  results  from  douch- 
ing, misleading  the  practitioner  as  to  the  nature  of  the 
malady,  limited  observation  indicates  that  copulation  sets 
the  infection  aflame.  In  such  cases  as  illustrated  by  Fig- 
ures 108  and  109,  the  catarrh  is  profuse,  but  not  generally 
fetid.  Like  tuberculosis  of  the  oviducts,  uterine  tuberculo- 
sis is  usually,  if  not  always,  symmetrical,  or  bicornual. 
Generally  the  uterus  contracts  extensive  pelvic  adhesions. 


342 


Diseases  of  the  Genital  Organs 


t 


r 


-  -  "^^ 


.4 


..  CL 

s  • 
Ov 


mi 


c- 


0  c 


/  V 


Tb 


^ 


Vie.  105. 
Horizontal  section  throuj^h  dorsal  surface  of  uterus,  coriuia,  ovaries,  and 
oviducts  of  Fifj.  104.  F,  Vajjina  ;  77),  tubercular  nodules  in  rij^ht  vaginal 
walls  (below)  ;  C,  cervical  wall  ;  CC\  cervical  canal  ;  f ',  uterus;  '/'/>,  tuber- 
cles in  cornua  (above)  ;  O,  O,  ovaries  ;  CL,  corpus  luteuni  in  rijjht  ovary  ; 
Ov,  tubercular  oviduct  j^reatly  enlart^ed  and  elonjijated,  pushed  laterally  far 
beyond  the  ovary  ;   (JC,  uterine  corn  u. 


Tuberculosis  of  the  Female  Genitalia  343 

In  many  cases  the  peritoneum  is  so  involved  that,  ovaries, 
oviducts,  uterus,  and  broad  ligaments  constitute  a  complex 
adherent  mass,  as  in  Figures  104  and  106,  where  it  is  diffi- 
cult, though  generally  possible,  to  identify  the  various  parts 
by  rectal  palpation.  Pelvic  adhesions  due  to  genital  tuber- 
culosis resemble  those  caused  by  other  infections.  The  ad- 
hesions due  to  tuberculosis  are  often  accompanied  by  palpa- 
ble tubercles.  Their  recognition  aids  materially  in  diagno- 
sis. Non-tuberculous  pelvic  adhesions  are  frequently  ac- 
companied by  sclerotic  abscesses  of  an  ovary,  oviduct,  uter- 
ine horn,  or  the  three  areas  combined.  In  my  collection,  no 
abscesses  exist  in  any  case  of  tubo-uterine  tuberculosis,  not 
even  abscesses  of  the  lymph  glands  in  the  broad  ligaments 
of  the  uterus.  Tuberculous  pyosalpinx  and  pyometra,  with 
necrosis  of  the  uterine  mucosa,  as  indicated  in  Figures  96 
and  97,  is  common  enough.  There  is  one  important  differ- 
ence in  the  clinical  history  of  tuberculous  and  non-tubercu- 
lous pelvic  adhesions.  The  non-tuberculous  adhesions  are 
commonly  preceded  by  acute  metritis,  largely  with  placen- 
titis and  retained  fetal  membranes ;  tuberculous  pelvic  ad- 
hesions ordinarily  arise  independently  of  acute  metritis. 

The  cow  from  which  Figures  104  and  105  were  taken  was 
entered  in  our  clinic  for  sterility.  There  was  slight  uterine 
catarrh  (tuberculosis  of  the  uterine  mucosa)  which  abated 
under  antiseptic  douches.  The  ovaries,  oviducts,  and  uterus 
were  normal  by  rectal  palpation.  She  appeared  so  well  that 
she  was  mated  with  a  valuable  herd  sire.  Soon  afterward, 
she  broke  down,  and  upon  re-examination  genital  tubercu- 
losis was  evident.  When  destroyed,  extensive  generalized 
tuberculosis  was  revealed.  She  entered  our  clinic  without  a 
history,  but  upon  the  assumption  of  freedom  from  tubercu- 
losis, and  no  careful  search  was  made  in  that  direction.  Ap- 
parently the  disease  was  forced  to  its  crisis  by  copulation, 
the  patient  gave  way  to  the  infection,  and  a  diagnosis  of 
genital  tuberculosis  became  practicable.  Fortunately  the 
sire  escaped,  largely  perhaps  because  the  cow  was  douched 
just  prior  to  copulation.  The  case  illustrates  vividly  the  in- 
sidious and  subtle  manner  in  which  genital  tuberculosis  in 


344  Diseases  of  the  Genital  Orgajis 

the  cow  may  develop,  and  how  the  veterinarian  needs  to  be 
on  his  guard. 

In  some  cases  the  tuberculous  uterus  remains  to  the  end 
free  from  adhesions,  as  in  Figures  107,  108  and  109.  In 
my  collection  some  of  the  uteri  in  which  the  mucosa  is  most 
extensively  involved  and  which  have  undergone  the  maxi- 
mum increase  in  size  have  suffered  least  from  pelvic  adhe- 


FiG.  io6— Tubercular  Genital  Tract  from  a  Non-Reacting  Cow  in 
Advanced  Tuberculosis. 
A  section  has  been  rcinove<l  from  Uie  dorsal  surface  cxposinjj;  the  iiilerior 
of  uterine  body  and  horns.  /.Cervix;  .?,  corniui  of  uterus  showing  tuber- 
cular masses  ;  j,  j,  j,  j,  sections  throu}.;li  the  oviducts  ;  7,  ./,  ovaries.  The 
left  ovary  (above)  was  buried  beneath  thr  adjaciiit  cornu,  _',  so  it  has  been 
excised  and  carried  out  where  it  comes  into  viiw. 


Tuberculosis  of  the  Female  Genitalia 


345 


346 


Diseases  of  the  Genital  Organs 


sions.  Is  this  because  in  such  cases  as  Figures  107  and  109 
the  infection  of  the  uterine  cavity  has  been  primary  (vene- 
real) and  in  those  cases  with  extensive  adhesions,  as  in 
Figures  104  and  106,  the  infection  has  invaded  the  tract  by 
continuity  from  the  general  peritoneum?  The  freedom  of 
the  oviducts  in  Figure  107  appears  to  emphasize  this  sug- 
gestion. 


^s. 


Fig.   io8— Uterine  Tuberculosis  Involving  chiefly  the  Uterine  Glands,  the 
peritoneum  being  free.     Longitudinal  Section  of  Fig.  107. 
CC,  Cervical  canal  ;  /,  \>\\s  in  cavity  of  cornu  ;   2,  pus  in  ajjcx  of  cornu. 

When  the  uterus  is  enlarged,  sclerotic  and  comparatively 
free  from  adhesions,  the  tuberculous  character  is  dilticult 
of  clinical  recognition.  One  may  meet  with  similar  sclero- 
tic hypertrophy  in  actinomycosis  (primary  genital)  and  in 
chronic  purulent  sclerotic  metritis  with  destruction  of  the 


Tuberculosis  of  the  Female  Gc7iitalia 


347 


b'--»^"^ 


X 


Fjg.  109— Advanced  Tubo-Uterine  Tuberculosis,  with  Necrosis  of 
Mucosa  and  Pyometra. 

Ov,  Oviduct,  greatly  enlarged   and  consisting  of  a  mass  of  tubercles  ; 
C  cervical  canal. 


348  Diseases  of  the  Genital  Origans 

uterine  mucosa.  In  such  cases,  however,  the  outlook  for  the 
breeding  life  of  the  patient  is  hopeless  and  an  accurate  clini- 
cal diagnosis  is  not  imperative.  In  some  cases  of  uterine 
tuberculosis,  the  masses  of  tubercles  are  so  voluminous  that 
they  throw  the  uterine  walls  into  great  transverse  folds 
which  may  be  palpated  per  rectum.  When  such  folds  are 
present,  they  have  a  distinct  diagnostic  value.  Usually  in 
chronic  abscessation  of  the  uterus  due  to  ordinary  pyogenic 
bacteria  or  to  actinomycosis,  while  the  uterus  is  enlarged 
and  hard,  it  is  very  irregular  in  outline.  At  one  point  there 
may  be  little  or  no  enlargement.  In  actinomycosis  and  in 
pyogenic  abscessation  of  the  genitalia,  some  one  part  usually 
contains  a  great  abscess  or  abscesses  quite  overshadowing 
other  lesions,  but  in  tuberculosis  there  is  a  strong  tendency 
to  symmetrical  enlargement.  The  two  horns  are  approxi- 
mately alike  in  volume,  form,  and  consistence.  This  is  im- 
portant to  remember  in  making  a  diagnosis.  In  one  cow  of 
great  breeding  value,  a  reactor  to  tuberculin,  which  had  not 
calved  for  two  years  and  had  long  suffered  from  an  abun- 
dant, fetid,  highly  repulsive  genital  discharge,  I  found  one 
uterine  horn  much  enlarged,  three  to  four  inches  in  its 
transverse  diameter,  very  hard,  and  irregular  in  contour. 
The  other  horn  was  approximately  normal.  The  findings 
by  palpation,  in  conjunction  with  her  reaction  to  tuberculin, 
led  me  to  diagnose  uterine  tuberculosis.  The  autopsy  re- 
vealed, instead,  a  macerating  fetus,  the  bones  of  which 
caused  the  irregular  bulging  of  the  cornu.  Had  I  recog- 
nized the  fact  that  in  uterine  tuberculosis  the  enlargement 
of  the  horns  is  usually  symmetrical  and  that  the  pus  from 
the  tuberculous  uterus  is  not  usually  fetid,  the  error  would 
probably  have  been  avoided.  In  those  cases  of  uterine  tu- 
berculosis where  only  the  superficial  mucous  layer  is  in- 
volved, as  in  Fig.  110,  the  diagnosis  by  ordinary  clinical  ex- 
amination fails.  The  ovaries,  oviducts,  and  uterus  are  nor- 
mal to  palpation,  the  uterine  catarrh  is  scant,  and  no  out- 
standing clinical  evidences  of  genital  tuberculosis  are 
present. 

The  outstanding  elements  in  the  differentiation  of  utoro- 


Tuberculosis  of  tJie  Female  denitalia  349 

tubal  tuberculosis  are  the  pelvic  adhesions,  the  tubercles  in 
the  genital  peritoneum,  the  symmetrical  enlargement  of  the 

uterus,  and  the  obstinate  uterine  catarrh.     No  one  of  these 


Fig.  1 10 — Miliary  Tuberculosis  of  the  Superficial  Uterine  Mucosa 

of  a  Virgin  Heifer. 

V,  Vagiua  ;    C  cervix;    UC,  uterine  cornu  ;   Oi\  oviduct.     The  uterine 

horns  are  laid  open  to  show  the  numerous  smaU  tubercles 

upon  the  mucous  surface 

symptoms,  alone,  is  sufficient  for  a  positive  diagnosis.  If 
the  patient  reacts  to  tuberculin,  the  probability  of  genital 
tuberculosis  is  increased.  No  data  are  at  hand  regarding 
bacterial  search  of  the  genital   discharges.     Such  search 


350 


Diseases  of  the  Getiiial  Organs 


would  probably  aid  materially  in  diagnosis.  A  negative 
tuberculin  test  is  not  conclusive  evidence  that  genital  tuber- 
culosis is  not  present.  The  very  valuable  herd  bull,  from 
w^hich  Figure  96  was  made,  quite  certainly  contracted  the 
infection  from  a  cow  which  had  successfully  passed  several 
tuberculin  tests,  in  spite  of  severe  generalized,  utero-tubal 
tuberculosis,  and  marked  uterine  catarrh.  While  in  many 
cases,  such  as  delineated  in  Figure  104,  quite  an  accurate 
physical  diagnosis  of  genital  tuberculosis  may  be  made,  not 
all  cases  may  be  detected.  The  important  point  is  that 
utero-tubal  tuberculosis  may  almost  always  be  tentatively 
diagnosed  by  rectal  palpation  and  the  veterinarian  and 
owner  placed  on  guard.  So  long  as  the  symptoms  named 
are  present,  the  tentative  diagnosis  of  utero-tubal  tubercu- 
losis is  not  only  justified,  but  obligatory,  from  the  sanitary 
standpoint.  When  uterine  catarrh  is  present,  copulation  is 
contra-indicated  by  every  consideration  of  hygiene.  Fer- 
tilization can  not  occur;  coitus  aggravates  the  catarrh  and 
imperils  the  bull.  The  retention  in  a  dairy  of  a  cow  with 
obstinate  uterine  catarrh  is  unjustified  by  every  considera- 
tion of  health  and  decency.  The  afflicted  animal  is  unfit  to 
associate  with  others  in  such  a  manner  that  their  food  may 
become  contaminated  with  the  genital  discharges. 

A  tentative  diagnosis  of  utero-tubal  tuberculosis  works  no 
serious  injury.  If  the  cow  recovers,  as  a  rule  the  recovery 
automatically  corrects  the  diagnosis ;  if  she  fails  to  recover, 
she  is  worthless  for  breeding  or  dairying,  and  fit  only  for 
slaughter,  whether  the  infection  be  tuberculous  or  not. 

(4)  Tuberculosis  of  the  cervix  is  presumably  rare.  I 
have  but  one  specimen  (Figures  111  and  112)  derived  from 
the  abattoir,  and  hence  without  a  clinical  history.  In  this 
case,  the  uterus  and  oviducts  are  also  involved.  The  illus- 
trations suggest  the  probable  clinical  features.  The  greatly 
swollen,  hard,  smooth  lips  of  the  cervix  could  not  well  be 
missed  by  an  expert  examining  the  genitalia  clinically. 
While  uterine  catarrh  was  evidently  present  in  this  animal, 
it  presumably  had  nothing  to  do  with  the  cervical  lesion. 
The  lesion  was  apparently  closed  and  caused  no  discharge. 


Tzcberciilosis  of  the  Female  Genitalia  35 1 

The  surgeon,  meeting  with  such  condition,  would  logically 
incise  the  tumor,  revealing  the  nature  of  the  lesion.  I  have 
repeatedly  opened  cysts  in  these  parts.  In  so  doing,  I  al- 
ways draw  the  cervix  back  into  the  vulva  before  operating, 
so  that  the  field  is  freely  open  to  view  and  the  contents 
which  may  be  released  are  readily  seen.  If  purulent,  they 
at  once  raise  the  question  of  tuberculosis,  which,  once  raised, 


Fig.  Ill — Tuberculosis  of  the  Vaginal  Portion  of  the  Cervix 

/,  Greatly  enlarged  tubercular  lip  of  os  uteri  externum  ;  2,  a  second,  lesser 

tubercular  tumefaction  of  lip  ;  j,  mucous  folds  of  the  first  annular 

cervical  fold.     Between  it  and  /  is  the  os  uteri  externum. 

should  not  be  dismissed  until  the  diagnosis  has  been  made 
perfectly  clear.  On  no  account  should  a  cow  be  permitted 
to  copulate  when  a  cervical  lesion  exists,  unless  it  is  clearly 
shown  to  be  non-tuberculous.  Even  harmless-appearing 
cysts  should  not  be  passed  over  carelessly.  Like  vulvar 
cysts,  discussed  below,  they  may  be  tuberculous.    The  cervi- 


352  Diseases  of  the  Genital  Organs 

cal  lesion,  when  open,  is  evidently  extremely  dangerous. 
These  cysts,  usually  found  laterally  from  the  os  uteri  ex- 
ternum, presumably  consist  of  retention  cysts  in  the  ducts 
of  Gartner  (See  page  39). 

(5)  Vaginal  tuberculosis  is  apparently  very  rare.  Fig- 
ure 105  illustrates  the  only  specimen  in  my  collection.  It 
was  not  recognized  clinically,  although  I  examined  the  pa- 
tient several  times.  However,  I  did  not  search  for  vaginal 
tuberculosis.     Possibly  it  was  of  recent  origin. 

It  is  important  for  the  veterinarian,  in  dealing  instru- 
mentally  with  diseases  of  the  genitalia,  to  bear  in  mind  that 
he  may,  by  the  careless  use  of  the  uterine  forceps,  implant 
the  infection  in  the  cervix,  or  in  the  vagina  at  its  point  of 
continuity  with  the  cervix.  He  may  re-infect  these  parts, 
through  instrumental  lesion,  with  the  discharges  from  the 
patient's  uterus.  If  careless  in  his  methods,  he  may  carry 
the  infection  from  a  tuberculous  cow  to  a  healthy  one.  Un- 
der reasonable  precautions,  the  danger  is  quite  negligible. 
Figure  105  shows  the  tuberculous  lesions  within  the  vaginal 
wall,  closed.  If  open,  the  lesion  would  have  the  same  danger 
as  an  open  lesion  of  the  cervix. 

(6)  Vulva?'  tuberculosis  has  occurred  twice  in  my  prac- 
tice, each  time  readily  diagnosed,  though  in  one  case  the 
nature  of  the  lesion  was  at  first  misleading.  In  this  case, 
at  the  first  examination,  a  cyst  one  inch  in  diameter,  located 
apparently  in  Bartholin's  gland  (See  page  44),  was  incised, 
and  a  small  amount  of  sero-purulent  content  escaped.  Prior 
to  my  next  examination,  the  patient  had  reacted  to  the  tu- 
berculin test.  When  I  examined  her,  the  lesion  presented 
the  typical  characters  of  a  tuberculous  ulcer.  My  second 
case  was  more  readily  diagnosed.  The  vulvar  lip,  which 
was  swollen  and  sclerotic,  presented  an  old  fistulous  open- 
ing, from  which  small  volumes  of  thick  pus  could  be  pressed 
out.  Centripetally,  a  tuberculous  gland,  two  to  three  inches 
in  diameter,  lay  alongside  the  vagina.  In  addition,  both 
supramammary  glands  were  greatly  enlarged,  and  at  each 
internal  inguinal  ring  glands  three  inches  in  diameter  were 
palpable.  Autopsy  showed  extensive  generalized  tubercu- 
losis. 


Ticberculosis  of  the  Female  Gefiitalia 


353 


Vulvar  tuberculosis  is  evidently  a  very  dangerous  type  for 
the  bull.  In  my  second  case,  the  cow  had  been  bred  only  a 
few  days  before  my  examination  to  the  herd  bull,  valued  at 
more  than  ten  thousand  dollars.  Fortunately  he  escaped 
infection. 


Fig.  112— Sagittal  Section,  of  Fig.  iii. 
Os,  Os  uteri  externum  ;   C,  cervical  canal ;     fb  tubercles  in  lip  of  os  uteri  : 
A,  A,  tuljercular  abscesses. 

The  importance  of  genital  tuberculosis  in  cattle  calls  for 
much  greater  interest  upon  the  part  of  the  veterinarian. 
In  dairies  and  pedigreed  breeding  herds,  tubercular  uterine 
catarrh  is  one  of  the  most  dangerous  and  repulsive  types  of 
tuberculosis.  The  search  is  generally  limited  to  the  tuber- 
culin test,  which  too  often  fails  to  detect  the  disease.  The 
cow  whose  uterus  is  shown  in  Fig.  94  belonged  in  a  small, 

23 


354  Diseases  of  the  Genital  Organs 

high-class  Guernsey  herd  which  had  been  tested  semi-annu- 
ally for  several  years.  This  cow  passed  each  test  satisfac- 
torily. Each  test  revealed  reactors,  which  upon  slaughter 
showed  recent  lesions  only.  It  was  evident  that  lurking 
somewhere  in  the  herd  was  a  non-reacting  spreader  of  a 
dangerous  type.  In  making  a  survey  of  the  genital  organs 
of  the  herd,  with  reference  to  breeding,  I  designated  this 
animal  as  the  non-reacting  spreader. 

When  diseases  of  the  genitalia  occur,  closing  the  breeding 
career  of  an  animal,  a  definite  diagnosis  is  of  great  im- 
portance. If  tuberculosis  is  the  probable  or  possible  cause 
of  sterility,  but  can  not  be  clearly  diagnosed  clinically, 
slaughter  without  accurate  post-mortem  diagnosis  is  wholly 
unjustifiable.  If  a  cow  is  sterile  because  of  genital  tuber- 
culosis, she  has  almost  certainly  seriously  endangered  the 
bull  and  other  cattle.  If  a  bull  becomes  disabled  for  coitus 
because  of  genital  tuberculosis,  it  is  not  enough  to  send  him 
to  the  shambles  because  he  can  no  longer  be  used  for  breed- 
ing. Somewhere  there  is  almost  certainly  a  cow  with  geni- 
tal tuberculosis  which  transmitted  the  infection  to  him  dur- 
ing coitus.  She  is  liable  to  transmit  the  infection  to  another 
bull  and  is  highly  dangerous  to  other  cows.  The  diagnosis 
of  tuberculosis  in  the  bull  is  therefore  highly  necessary  for 
the  control  of  the  disease  in  contact  animals.  For  this  pur- 
pose post-mortem  is  as  valuable  as  clinical  diagnosis. 

The  control  of  these  dangers  evidently  depends  chiefly 
upon  the  more  general  and  accurate  diagnosis  of  genital  le- 
sions in  both  sexes  and  the  more  general  adoption  of  efficient 
sex  hygiene  in  breeding  cattle.  The  lesions  are  to  be  de- 
tected through  two  chief  agencies — dairy  inspection  and  in- 
spection of  the  genitalia  in  connection  with  sterility.  At 
present,  dairy  inspection  fails  utterly  in  most  cases  in  rela- 
tion to  genital  disorders.  Repeatedly  I  find,  in  regularly  in- 
spected herds,  and  even  in  certified  dairies,  cows  with 
quarts  or  gallons  of  fetid  pus  in  the  uterine  cavity,  large 
volumes  of  which  are  pressed  out  from  time  to  time  while 
the  cows  are  lying  down.  Advancement  in  this  field  is  one 
of  the  most  urgently  needed  reforms  in  dairy  inspection. 


Tuberculosis  of  the  Female  Genitalia  355 

The  greatest  weapon  for  the  control  of  the  danger  Hes  in 
the  more  general  inspection  of  the  genitalia  of  cattle,  as  a 
safeguard  against  sterility  and  abortion.  It  is  becoming 
more  and  more  apparent  that  a  careful  physical  examina- 
tion of  the  genitalia  of  cows,  prior  to  breeding,  is  a  wise 
precaution  of  distinct  scientific  and  economic  importance, 
and  that  the  breeder  should  take  far  greater  care  in  the  sex 
hygiene  of  the  bull.  If  penial  injuries  and  infections  are  to 
be  averted,  having  first  ascertained  that  the  genital  organs 
of  the  cow  are  healthy,  the  external  genitalia  of  both  cow 
and  bull  should  be  carefully  washed  before  permitting  copu- 
lation. It  is  highly  important,  in  the  prevention  of  penial 
lesions,  which  may  serve  as  infection  avenues,  that  the 
crusts  of  pus  in  the  vulvar  tuft  of  hairs  of  the  cow  be  re- 
moved by  washing.  Otherwise,  these  crusts  of  pus  may  be 
caught  and  forced  into  the  vulvar  opening,  to  abrade  the 
penial  mucosa.  After  copulation,  the  penis,  prepuce,  and 
sheath  of  the  bull  should  again  be  carefully  and  efliciently 
douched.  These  precautions  go  hand  in  hand  with  those 
designed  to  control  sterility  and  abortion. 


CHAPTER  XIV 

THE  GENERAL  INFECTIONS  OF  THE  GENITAL 
ORGANS  OF  CATTLE 

The  mammalian  genital  tract  opens  freely  upon  the  ex- 
terior, rendering  it  possible  for  any  infection  upon  the  ad- 
jacent body  surface,  capable  of  growing  within  the  genital 
tract,  to  invade  it,  either  actively  or  passively  through  the 
agency  of  a  bearer  (copulatory  organs  of  the  opposite  sex 
during  coitus,  surgical  instruments,  hands  of  operator). 
Vastly  more  important,  as  far  as  at  present  known,  is  the 
transmission  of  important  infections  from  the  alimentary 
and  pulmonary  tracts,  through  the  blood  stream,  to  the  geni- 
tal tract.  Thence  the  infection  is  carried,  in  the  female, 
back  to  the  alimentary  tract  of  the  fetus.  That  is,  as  will  be 
more  fully  discussed  when  considering  fetal  infections,  if 
there  is  infection  in  the  uterus  of  the  pregnant  female 
(which  is  the  rule)  it  tends  to  penetrate  the  thin  chorion 
and  amnion  and  to  be  swallowed  promptly  by  the  fetus, 
along  with  the  amniotic  fluid.  If  the  fetus  has  sufticient 
vigor,  the  bacteria  are  harmlessly  included  as  a  component 
part  of  the  meconium,  to  be  expelled  soon  after  birth  ;  if  dis- 
ease of  the  fetus  occurs  before  birth,  and  the  gastro-intes- 
tinal  epithelium  is  destroyed  or  devitalized,  infection  ensues. 
The  bacteria  may  then  enter  the  blood  stream,  to  be  lodged 
later  in  the  articulations  (arthritis)  but,  since  they  were 
originally  derived  from  the  genital  tract  of  the  mother,  tend 
logically  to  return  to  the  genitalia.  If  the  infections  within 
the  uterus  of  the  pregnant  cow  commonly  invade  the  ali- 
mentary tract  of  the  fetus,  it  follows  that  subsequent  to 
birth  the  same  infections  may  be  expelled  from  the  diseased 
uterus,  contaminate  the  milk,  be  swallowed  by  the  calf,  and 
cause  disease  having  the  same  peril  for  it  as  if  the  infection 
had  been  swallowed  prior  to  birth. 

Each  year  adds  to  the  number  of  known  species  of  micro- 
organisms capable  of  invading  the  genital  tract  of  cattle 
and  of  other  domestic  animals  and,  according  to  the  best 


The  Gefieral  Infections  of  the  Genital  Organs  of  Cattle     357 

available  evidence,  capable  of  attaining  such  intensity  as  to 
interfere  seriously  with  the  reproductive  functions.  They 
may  reside  indefinitely  in  the  genital  tract  without  causing 
disaster  but  ready  at  any  time,  taking  advantage  of  an  in- 
jury to,  or  loss  of  vigor  in,  the  area  occupied,  to  cause  seri- 
ous harm.  Their  method  of  injury,  however,  is  less  definite 
in  character  for  each  recognizable  organism  than  the  patho- 
logic processes  described  in  the  preceding  sections.  The 
vesicular  venereal  disease  stands  out  definitely,  by  its  symp- 
toms and  clinical  history  of  transmission,  as  a  specific  con- 
tagion. The  nodular  venereal  disease  offers  a  distinct  and 
characteristic  lesion,  although  its  cause  it  not  definitely  de- 
termined and  its  importance  is  largely  a  matter  of  opinion. 
Actinomycosis  and  tuberculosis  are  fully  recognized  as  spe- 
cific diseases  causing  genital  injuries  identical  with  well 
recognized  lesions  in  other  organs,  each  of  which  is  due  to 
a  recognized  species  of  organism. 

In  the  following  section  there  will  be  discussed,  as  general 
infections,  an  extensive  group  of  lesions  due  to,  or  believed 
to  be  due  to,  infection  which  far  surpasses,  in  its  peril  to 
the  reproductive  organs,  the  four  preceding  diseases.  Each 
may  severally  or  jointly  produce  a  variety  of  lesions,  but  no 
one  lesion  can  with  confidence  be  attributed  clinically  to  any 
one  organism.  Several  or  many  different  bacteria  or  other 
organisms  may  cause  ovaritis,  salpingitis,  metritis,  or  cervi- 
citis, and  these  lesions  may  prevent,  interrupt,  or  imperil 
reproduction.  Moreover,  it  is  difficult  or  impossible  to  dif- 
ferentiate clinically  between  them.  If  salpingitis  is  present 
and  diagnosable,  it  may  be  due  to  a  streptococcus,  a  bacillus, 
or  a  micrococcus,  or  to  a  combination  of  the  three,  but  the 
exact  status  can  be  determined  only  by  a  bacterial  study  of 
the  diseased  tube  after  its  removal  from  the  abdominal  cav- 
ity. They  will  be  discussed,  therefore,  as  a  group  having  a 
common  tendency  to  cause  an  extensive  list  of  pathologic 
changes  with  serious  injury  to  the  reproductive  functions. 
The  lesions  produced  by  the  infection — not  the  identity  of 
the  infecting  agent — will  constitute  the  basis  for  classifica- 
tion. , 


358  Diseases  of  the  Genital  Organs 

I.  THE  GENERAL  INFECTIONS  OF  THE  GENITAL 
ORGANS  OF  BULLS 

The  diseases  of  the  genital  organs  of  bulls,  as  a  factor  in 
the  problem  of  reproduction,  have  received  scant  attention 
from  veterinarians.  A  belief  had  grown  up  and  held  the 
undivided  attention  of  veterinarian,  dairyman,  and  breeder, 
that  the  great  and  only  important  menace  to  reproduction 
in  cattle  was  a  specific  infectious  disease  of  the  pregnant 
female,  designated  ''contagious  abortion."  During  the  past 
few  years  that  belief  has  been  undergoing  disintegration, 
until  very  few  veterinarians  now  cling  unreservedly  to  the 
tradition.  There  has  been  much  unintelligent  controversy 
over  the  part  played  by  the  bull  in  genital  diseases  of  cattle, 
because  consideration  has  been  largely  restricted  to  the 
question  of  the  part  played  by  the  bull  in  transmitting  to 
cows  the  bacillus  discovered  by  Professor  Bang,  which  was 
regarded  as  the  specific  cause  of  the  abortions  occurring  in 
cattle.  The  attitude  assumed  was  that  the  only  infection  of 
interest  which,  attacking  the  genital  organs  of  a  bull,  might 
possess  danger  for  a  cow  with  which  he  might  copulate  was 
the  B.  abortus.  If,  therefore,  a  bull  was  not  ejaculating  with 
his  semen  the  B.  abortus,  he  was  assumed  to  be  virtually  be- 
yond criticism  from  the  standpoint  of  infection.  The  study 
of  the  semen  of  bulls  and  the  bacteriology  of  the  genital  or- 
gans and  of  the  semen,  except  for  a  few  searches  made  for 
the  B.  abortus,  have  been  of  no  consequence.  Little  or  noth- 
ing was  known  of  the  diseases  of  the  testicles,  unless  they 
became  enormously  enlarged  or  underwent  abscessation. 
The  subsidiary  structures — the  epididymis,  vas  deferens, 
vesiculae  seminales,  prostate  and  Cowper's  glands — were  ig- 
nored. These  facts  show  the  strangling  grip  so  long  held 
by  "contagious  abortion"  upon  the  study  of  the  infections 
of  the  genital  organs. 

The  time  has  arrived  for  a  frank  recognition  by  breeder 
and  veterinarian  that  the  bull  is  one-half  the  breeding  herd, 
that  the  other  half  is  valuless  unless  he  is  genitally  sound, 
and  that,  speaking  in  percentages,  he  is  probably  as  great  an 
offender  as  the  cow.     In  other  words,  probably  as  large  a 


The  General  Infections  of  the  Geyiital  Organs  of  Cattle 


559 


proportion  of  bulls  as  of  cows  go  to  slaughter  on  account  of 
sterilitj^  or  low  fertility. 

A  general  outline  for  the  clinical  examination  of  the  geni- 
tal organs  and  the  semen  of  bulls  has  been  given  in  Chapter 
II.  It  remains  to  describe  more  fully  the  examination  of 
the  semen  in  the  course  of  genital  diseases  and  to  point  out 
as  far  as  possible  the  relation  of  changes  in  the  semen,  and 
especially  in  the  spermatozoa,  to  clinical  manifestations  of 
genital  disease. 

'The  technique  which  I  have  pursued  in  collecting  and 
examining  semen  from  bulls  is  as  follows : 

The  bull's  sheath  is  first  douched  with  V-2  per  cent.  Lugol's 
solution  or  \U  per  cent,  chlorazene.  The  cow's  buttocks  are 
thoroughly  cleansed  with  a  disinfectant  and  washed  with  a 
1/2  per  cent,  chlorazene  solution,  and  the  vaginal  mucus  is 
removed  manually.  If  a  bacteriological  examination  of  the 
semen  is  desired,  the  vagina  should  be  thoroughly  cleansed 
with  a  douche  of  14  per  cent,  chlorazene,  which  must  be  com- 
pletely removed  several  minutes  before  copulation.  As  only 
a  slight  trace  of  chlorine  or  other  disinfectant  will  cause  im- 
mobility of  the  sperm  cell,  it  is  desirable  that  cleansing  of 
the  parts  for  studying  the  motility  of  the  spermatozoa  be 
done  with  sterile  water  or  a  normal  saline  solution.  In 
either  case,  all  possible  vaginal  mucus  should  be  removed, 
just  prior  to  service,  with  the  well  disinfected  hand  which 
has  been  washed  with  sterile  water.  The  method  is  not  en- 
tirely satisfactory  from  the  bacteriological  standpoint.  Two 
sources  of  bacterial  contamination  must  be  considered : 
first,  extraneous,  and  second,  the  vaginal  flora.  Contamina- 
tion from  the  first  source  may  be  largely  prevented  by  care- 
fully cleansing  the  parts  immediately  prior  to  inserting  the 
hand  for  the  sample,  but,  owing  to  the  almost  constant  fecal 
contamination  of  the  vulva  and  the  adjacent  parts,  it  is  well- 
nigh  impossible  wholly  to  prevent  contamination   during 

'  The  results  of  clinical  examinations  of  bulls,  with  directions  for  the  ex- 
amination of  semen  and  spermatozoa  from  diseased  or  suspected  bulls,  are 
by  \V.  W.  Williams  ;  the  micro-photographs  of  the  preparations  are  by 
Professor  B.  F.  Kingsburv. 


360  Diseases  of  the  Genital  Organs 

coitus.  The  danger  of  contamination  of  the  semen  from  the 
vaginal  flora,  although  undoubtedly  lessened  by  the  above 
method,  can  not  be  said  to  be  nullified.  Some  other  technique 
may  lessen  the  contamination  from  each  source. 

Recently  I  have  used  a  common  sputum  cup  for  the  with- 
drawal of  samples  from  the  vagina.  This  method  has  con- 
siderable advantage  in  the  prevention  of  contamination.  An 
examination  of  the  vaginal  mucus  taken  prior  to  service 
may  serve  as  a  check  on  the  vaginal  flora.  With  careful 
disinfection,  it  seems  that  many  samples  may  be  taken  free 
from  fecal  flora,  as  only  a  few  give  a  growth  of  the  colon 
group.  If  the  sample  is  to  undergo  a  bacteriological  ex- 
amination, it  should  be  placed  in  a  sterile  vial,  cooled  im- 
mediately, and  cultured  at  the  earliest  possible  date.  Semen 
for  clinical  and  histological  examination  must  be  placed  in 
a  warm  vial,  kept  at  a  temperature  ranging  from  100^  to 
104°  F,,  and  examined  under  the  microscope  within  thirty 
to  forty-five  minutes  after  sampling. 

First,  the  physical  characters  of  the  semen  are  noted,  in- 
cluding the  quantity,  color,  consistency,  and  coagulability. 
A  drop  of  semen  is  then  placed  on  a  warm  microscope  slide 
and  covered  with  a  thin  cover  glass.  Under  a  low-power 
lens,  the  relative  abundance  of  the  spermatozoa  is  noted. 
The  semen  is  then  placed  under  an  oil  immersion  lens  in 
order  that  the  degree  of  motility  and  the  percentage  of  cells 
which  are  motile  may  be  observed.  When  possible,  the 
length  of  time  which  the  motility  continues  should  be  re- 
corded. I  have  observed  motility  as  much  as  four  hours 
after  taking  a  sample,  and  it  is  probable  that,  in  a  specimen 
kept  under  proper  conditions,  the  motility  outside  of  the 
female  genital  tract  continues  even  longer.  Much  of  the 
cellular  morphology  can  be  determined  by  examining  the 
fresh  specimen  under  the  oil  immersion  lens,  and  the  rela- 
tionship between  the  non-motility  and  the  morphological 
imperfection  can  be  established. 

For  the  determination  of  the  finer  morphological  details. 
a  stained  preparation  is  best.  The  film  should  be  made 
from  a  strictly  fresh  sample  of  semen,  fixed  with  heat,  and 


The  Gcverol  Infections  of  {he  Genital  Organs  of  Cattle     361 

the  mucus  removed  by  placing  it  in  a  0.5  per  cent,  chlora- 
zene  solution  for  eight  to  ten  minutes.  The  slide  is  then 
washed  with  clear  water,  to  remove  all  traces  of  chlorine, 
and  stained  with  carbol-fuchsin  with  heat  for  one  to  two 
minutes.  The  carbol-fuchsin  is  washed  off  with  water. 
The  film  is  stained  for  eight  minutes  with  alkaline  methy- 
lene blue.  Then  the  methylene  blue  is  washed  off  and  the 
film  is  dried  with  filter  paper.  The  head  of  the  healthy  cell 
should  be  brought  out  in  clear  detail.  The  neck  granule,  the 
cell  membrane,  and  the  nuclear  membrane  should  stain  very 
dark.  The  nucleus  should  stain  slightly  darker  than  the 
cytoplasm.  If  the  counterstaining  with  methylene  blue  is 
continued  only  about  five  seconds,  the  nucleus  remains 
bright  red  and  the  cytoplasm  stains  light  blue,  but  the  nu- 
clear membrane  is  left  indistinct.  The  nucleus  itself  retains 
an  alcoholic  eosin  stain  better  than  carbol-fuchsin,  but  after 
the  use  of  eosin  it  is  difficult  to  counterstain  so  as  to  bring 
out  the  details.  Recently,  I  have  used  acid  stain  consisting 
of  alcohol  two  parts,  carbol-fuchsin  two  parts  and  eosin  one 
part.  Staining  is  carried  on  one  and  one-half  minutes,  and 
the  cells  then  counterstained  with  a  fifty  per  cent.  Loeffler's 
methylene  blue  for  three  to  five  seconds.  By  this  method, 
an  exceptionally  clear  detail  is  obtained.  Various  stains 
may  be  used,  but  eosin  and  carbol-fuchsin  as  acid  stains  and 
Loeffier's  methylene  blue  as  a  basic  stain  have  been  found 
more  satisfactory  because  their  stability  makes  them  better 
for  field  use  than  many  of  the  aniline  stains.  Considerable 
experience  is  required  for  proficiency  in  the  proper  prepa- 
ration and  interpretation  of  stained  specimens. 

For  fecundation  it  is  necessary  that  a  healthy  sperm  cell 
unite  with  the  ovum.  Ostensibly  the  spermatozoon,  as  is 
the  case  with  other  cells  of  the  body,  may  undergo  certain 
destructive  or  degenerative  changes  affecting  its  physiologi- 
cal function.  This  may  occur  during  the  process  of  sperma- 
togenesis, in  which  case  the  immature  cells  are  eliminated, 
or  degenerative  changes  may  take  place  after  the  cells  have 
reached  maturity  and  while  they  lie  in  the  seminiferous  tu- 
bules or  epididymis.     If  the  sperm  cell  be  arrested  in  de- 


362  Diseases  of  the  Genital  Orgaiis 

velopment,  defective  or  weakened,  either  it  loses  its  ability 
to  unite  with  the  ^g%,  or,  if  union  takes  place,  the  fertilized 
ovum  undergoes  an  early  death  or  develops  a  constitution- 
ally weak  embryo.    Thus  Adami  and  Nicholas  state : 

"What  is  true  regarding  infectious  diseases  must  to  some 
extent  hold  also  regarding  chronic  intoxications  of  various 
orders.  The  results  of  constitutional  disease  in  either  parent 
may  be  the  following,  according,  on  the  one  hand,  to  the  ex- 
tent of  the  influence  of  the  disease,  or  intoxication,  upon 
the  germ  plasm  of  that  parent,  and  on  the  other,  to  the  ac- 
tivity or  potency  of  the  germinal  matter  contributed  by  the 
other  parent : 

1.  Sterility.  The  germ  cells  being  so  profoundly  modi- 
fied that  either  (a)  they  are  destroyed,  (b)  their  develop- 
ment is  arrested,  or,  (c)  being  developed  (ova  or  sperma- 
tozoa) ,  are  imperfect  and  incapable  of  fusing  with  the  germ 
cells  of  the  other  parent. 

2.  Imperfect  development  of  offspring,  (a)  Of  such  ex- 
tent as  to  lead  to  intra-uterine  death  and  abortion;  (b)  of 
less  extent,  a  viable  individual  being  produced  presenting 
either — 

(1)  Gross  anatomical  defects. 

(2)  No  gross  anatomical  defects,  but  lowered  vitality, 
presenting  itself  either  in  the  form  of  weakened  powers  of 
resistance  against  disease  in  general,  or  ( ?)  proneness  to 
develop  the  same  disease  as  the  parent." 

The  spermatozoa  which  I  have  studied  are  frequently 
characterized  by  definite  morphological  changes  in  the  cells. 
In  order  to  understand  fully  these  changes,  it  is  essential 
that  the  normal  spermatozoon  shall  be  known  and  the  eye 
trained  to  differentiate  between  the  normal  and  the  ab- 
normal. 

The  cell  is  divided  into  four  main  parts — head,  neck,  body 
and  tail. 

The  head,  oval  in  contour,  is  encompassed  by  a  thin  line, 
the  cell  membrane,  which  takes  an  acid  stain  more  deeply 
than  other  portions.  The  head  is  divided  into  two  portions 
— the  cytoplasmic  and  nuclear  elements — by  a  semi-ellipti- 


The  General  Infections  of  the  Genital  Organs  of  Cattle     363 

cal  line,  the  nuclear  membrane.  The  nucleus,  of  full  oval 
contour  except  at  its  base,  occupies  normally  a  little  more 
than  one-third  of  the  basal  area  of  the  head.  Its  sides  con- 
form to  the  general  contour  of  the  cell  membrane.  The 
chromasomic  material  does  not  occur  in  this  cell  as  definite 
granules,  but  is  disseminated  throughout  the  nucleus.  The 
nuclear  element  in  a  healthy  cell  takes  a  basic  stain,  and 
when  stained  with  methylene  blue  appears  very  slightly 
granular  and  darker  than  the  cytoplasm^ic  portion. 

The  cytoplasmJc  portion  of  the  head,  anteriorly  and  later- 
ally, corresponds  in  contour  with  the  general  oval  outline  of 
the  cell  membrane.  Caudally,  it  lies  against  the  nucleus, 
whose  convex  face  is  directed  into  the  base  of  the  cytoplasm, 
forming  a  shallow  cup  or  fovea  in  the  latter.  The  cytoplasm 
of  the  head  takes  carbol-fuchsin  very  faintly,  which,  when 
counterstained  with  methylene  blue,  is  entirely  replaced  by 
the  latter. 

The  neck  parts  in  the  bovine  spermatozoon  are  very  small 
and  not  defined  except  under  a  very  high  magnification.  In 
the  human  spermatozoon  two  neck  granules  are  described. 
In  spermatogenesis  they  arise  from  a  single  granule,  which 
in  the  last  stages  of  development  divides.  One  granule 
passes  to  the  caudal  end  of  the  neck  and  remains  there  in 
close  relation  to  the  connecting  piece  or  body;  the  other 
granule  passes  to  the  anterior  end  to  become  fused  with  the 
base  of  the  head.  If  such  separation  of  the  neck  granules 
occurs  in  the  bovine  spermatozoon,  it  is  not  brought  out  by 
my  present  method  of  staining.  The  neck  granule  appears 
as  a  single  bar,  fused  to  the  base  of  the  head.  Apparently 
there  is  a  slight  concavity  at  the  base,  into  which  the  neck 
is  inserted,  obscuring  most  of  it  from  view.  The  granule, 
fused  into  this  concavity,  appears  therefore  to  be  located 
within  the  nuclear  material;  this  is  undoubtedly  never  the 
case.  Aside  from  this  granule,  the  neck  remains  unstained 
under  the  methods  which  I  have  employed. 

By  the  embryologist  it  is  held  that,  when  fecundation 
takes  place,  the  sperm  head  enters  the  cell  membrane  of  the 
ovum.     The  sperm  then  loses  its  tail,  which  separates  be- 


.364  Diseases  of  the  Genital  Organs 

tween  the  neck  and  connecting  piece.  It  appears  then  that 
the  head,  which  has  up  to  now  faced  the  center  of  the  cell, 
becomes  reversed  and  faces  the  cell  wall.  From  the  neck 
granules,  which  migrate  toward  the  center  of  the  cell,  are 
formed  the  centrasomes,  or  polar  bodies,  which  play  such  an 
important  part  in  the  mitotic  process. 

It  is  quite  clear  that  an  arrest  in  the  development  of  the 
centrosmic  precursor  may  be  a  potent  cause  of  sterility. 
Judging  from  some  stained  preparations  on  hand,  it  appears 
quite  certain  that  this  arrest  in  development  occurs  to  a 
greater  or  less  degree. 

The  body,  cylindrical  in  form,  about  one  and  one-third 
times  the  length  of  the  head,  takes  readily  either  acid  or 
basic  stain,  and  reveals  in  the  properly  stained  preparation 
a  spiral  filament  encircling  its  entire  length.  The  body  is 
succeeded  by  the  tail,  of  slightly  smaller  diameter  and  about 
four  times  as  long.  The  tail,  tapering  posteriorly,  ends  as  a 
very  fine  filament.  As  the  body  and  tail  function  only  in  a 
locomotive  capacity,  I  shall  not  deal  further  with  them,  but 
shall  study  the  pathologic  changes  in  the  heads  of  various 
samples  of  spermatozoa,  and  the  accompanying  gross  anato- 
mical and  functional  changes  in  the  genital  apparatus  of  the 
bull. 

Bull  Jf,  Figs.  113,  114.  Eleven  years  old.  For  three  years 
was  used  as  sire  in  a  herd  of  about  one  hundred  mature  fe- 
males. Served  sixty-three  cows,  with  two  hundred  and 
fifty-one  copulations,  seventy-five  (29.8  per  cent.)  of  which 
resulted  in  conception.  In  1916,  ten  cows  were  served,  of 
which  twenty  per  cent,  failed  to  conceive  and  twenty-five 
per  cent,  of  those  conceiving  aborted.  In  1917.  thirty-six 
cows  were  bred,  of  which  11.1  per  cent,  failed  to  conceive 
and  21.95  per  cent,  of  those  conceiving  aborted.  In  1918, 
forty  cows  were  bred,  of  which  35.6  per  cent,  failed  to  con- 
ceive and  27  per  cent,  of  those  conceiving  aborted.  In  1919, 
thirty-eight  cows  were  bred,  of  which  79  per  cent,  failed  to 
conceive  and  40  per  cent,  of  those  conceiving  aborted. 

After  about  three  or  four  months  in  the  herd,  the  bull's 
fertility  became  lessened.     Since  May  1,  1919,  he  has  been 


1  he  General  Infections  of  the  Genital  Organs  of  Cattle     365- 

used  frequently,  with  no  conceptions.  The  sudden  sterility 
of  about  75  per  cent,  of  the  herd  had  been  thought  to  be  due 
wholly  to  the  condition  of  the  cows.  A  large  proportion  of 
the  cows  (36.5  per  cent,  of  those  served)  showed  macro- 
scopic pathologic  changes,  especially  cervicitis,  but  only  in 
a  few  cases  of  sufficient  severity  to  account  for  sterility  on 
such  a  large  scale. 


Fig.   113 — Spermatozoa  from  Bull  No.  4. 

Number   comparatively   low.     Cells    non-motile    when    ejaculated. 
Many  Tailless  Spermatozoa. 

On  Dec.  5,  physical  examination  revealed  a  severe  balano- 
posthitis  and  testicles  slightly  atrophied,  with  slightly  di- 
minished tone.  Coitus  was  normal.  About  7  mils,  of  semen 
were  obtained,  which  was  very  viscid,  of  a  light  straw 
color,  and  more  translucent  than  normal. 

The  spermatozoa  were  non-motile.  About  fifty  per  cent, 
of  the  normal  number  were  present.  In  fresh  specimens, 
many  spermatozoa  lay  upon  their  sides,  giving  the  appear- 
ance of  extremely  narrow  heads.     In  stained  preparations 


366 


Diseases  of  the  Genital  Organs 


many  detached  tails  were  present.  The  head  stained  as  a 
homogeneous  mass  instead  of  showing  its  component  parts 
as  in  the  healthy  cell.  In  this  specimen  of  spermatozoa 
there  appeared  to  be  a  total  absence  of  the  nuclear  mem- 
brane, and  in  many  cells  the  upper  granules  were  missing. 
There  was  an  almost  total  disintegration  or  arrest  in  devel- 
opment of  the  integral  cellular  elements — the  nucleus  and 


Fig.  1 14— Spermatozoa  obtained  from  Bull  No.  4. 

Taken  25  days  after  those  shown  in  Fis^.  113,   (lurin<^  which  period  the  bull 

had  complete  sexual  rest.     Sperniato/oa  were  still   non-motile, 

but  sliowed  better  staining  (jualilies. 


neck  granule.     On  Dec.  5th,   1919,  this  bull  was  ordered 
withdrawn  from  service. 

On  Dec.  30th,  after  twenty-five  days  of  complete  sexual 
rest,  another  sample  (Fig.  114)  was  obtained,  which 
showed  a  remarkable  improvement  in  the  staining  qualities. 
The  cell  was  not  normal,  though  the  head  stained  much  bet- 
ter. The  connecting  piece  appeared  enlarged  and  was  con- 
torted by  the  presence  of  a  much  enlarged  spiral  filament. 


The  General  Infections  of  the  Genital  Organs  of  Cattle     367 

Ordinarily  the  filament  is  so  small  that  special  staining  is 
required  to  show  it.  The  nuclear  portions  of  the  heads  were 
uniformly  undersized.  It  was  ordered  that  this  bull  should 
have  complete  sexual  rest  until  further  study  should  deter- 
mine a  more  normal  condition  of  the  semen  and  sperma- 
tozoa. 

Jan.  29,  1920.     Motility  still  absent  and  fewer  spermato- 


FiG.  115— Spermatozoa  from  Bull  No.  5. 

Spermatozoa  motile,  but  heads  abnormally  narrow  and   nuclei   verv  small. 


zoa.  About  fifty  per  cent,  of  the  spermatozoa  w^ere  tailless. 
Many  of  the  heads  had  a  very  narrow  tapering  basal  por- 
tion, running  to  a  point  at  its  juncture  with  the  neck.  The 
nuclear  portion  was  generally  differentiated,  but  not  as  dis- 
tinct as  normal.  The  neck  granules  were  very  small  and 
generally  imperceptible. 

Mar.  6,  1920.  Physical  examination  revealed  no  changes. 
Twenty  mils,  of  semen  were  obtained,  containing  considera- 
ble vaginal  mucus.    The  semen  was  very  viscid,  and  at  first 


368  Diseases  of  the  Genital  Organs 

slightly  turbid.  Firm  coagulum  formed  within  thirty  min- 
utes. The  sperm  cells  were  decreased  in  numbers  and  non- 
motile.  There  was  a  slight  microcephalia  and  many  loos- 
ened heads  throughout  the  sample. 

April  5,  1920.  Physical  examination  revealed  no  new 
macroscopic  changes.  About  twenty  mils,  of  turbid,  semi- 
translucent  semen  were  obtained,  containing  considerable 


Fig.  116 — Spermatozoa  from  Bull  No.  7. 

Many  with  small  lic-ads  and  atrophic  nucleus. 

epithelial  debris.  A  firm  coagulum  appeared  almost  imme- 
diately after  obtained,  leaving  the  main  part  of  the  mucus 
colorless  and  translucent.  Sperm  cells,  entirely  non-motile, 
were  present  in  numbers  not  to  exceed  twenty-five  to  fifty 
per  cent,  of  normal.  Fifty  per  cent,  of  the  spermatozoa 
were  without  tails.  Almost  all  were  microcephalic,  espe- 
cially those  which  were  tailless.  In  these  there  was  a  very 
marked  diminution  in  size  and  uniform  tapering  of  the 
basal  portion  of  the  head.     In  most  heads  the  nuclear  por- 


The  Ge?ieral  Infections  of  the  Genital  Organs  of  Cattle     369 

tion  was  clearly  defined.    The  neck  granule  was  either  ab- 
sent or  very  small  and  stained  faintly. 

Bull  5,  Fig.  115.  Eighteen  months  old.  Served  twelve 
cows,  with  but  one  conception.  The  seminal  vesicles  ap- 
peared slightly  arrested  in  development  and  the  left  gland 
was  inflamed.  Four  to  seven  mils,  of  seminal  fluid  were  ob- 
tained, containing  motile  atypical  spermatozoa.     The  head 


M 


Fig.    117.     Spermatozoa  from  Bull  No.  8. 

Cells  show  degeneration,  as  indicated  by  want  of  definition  of  the  nucleus. 

Some  cells  are  abnormally  large. 

was  narrower  than  normal  and  the  nucleus  constricted, 
causing  a  marked  decrease,  not  only  in  the  breadth,  but  in 
the  total  volume  of  the  cell.  The  component  parts  were  clear 
in  detail,  but  arrested  in  development.  Streptococcus  viri- 
dans  and  staphylococcus  albus  and  aureus  appeared  in  cul- 
ture from  this  sample. 

Bull  1.  Imported.  About  five  years  old.  Served  seven 
heifers,  one  or  two  of  them  twice,  with  no  conceptions.  All 
seven  conceived  from  first  service  by  another  bull. 


370  Diseases  of  the  Genital  Organs 

Examination  revealed  granular  balanitis.  On  the  left  side 
there  was  orchitis,  epididymitis,  and  spermatocystitis.  Both 
vesicles  were  enlarged.  So  far  I  have  been  unable  to  get  a 
sample  of  semen  from  this  bull.  More  recently  fluid  of 
lymph-like  consistency  has  been  palpated  in  the  left  seminal 
vesicle.     (See  Figs.  86,  126,  127.) 

Bull  7,  Fig.  116.  Out  of  a  total  of  sixty-three  cows  served 
in  the  past  three  years,  there  have  been  forty  (66  per  cent.) 
conceptions,  nine  (22.5  per  cent.)  of  which  have  resulted  in 
abortion.  This  bull  is  not  the  chief  sire  of  the  herd.  Al- 
most all  repetitions  of  service  in  the  herd  are  with  cows  on 
which  this  bull  has  been  used.  Only  two  abortions  have  oc- 
curred amongst  cows  bred  to  other  bulls.  Cows  bred  to 
other  bulls  have  almost  invariably  conceived  at  first  service, 
but  repetitions  are  frequent  with  Bull  7.  The  vitality  of  his 
progeny  is  generally  below  normal. 

Physical  examination  showed  all  genital  parts  apparently 
normal.  Coitus  was  normal.  Ten  mils,  of  macroscopically 
normal  semen  were  obtained.  Smears  showed  cocci  which 
failed  to  grow  in  cultures.  There  were  also  present  large 
Gram  positive  rods.  Paracolon  bacilli  were  obtained  on 
culture.  Motility  of  spermatozoa  normal.  The  heads  were 
slightly  smaller  than  normal,  with  a  very  evident  arrest  in 
development,  affecting  principally  the  nucleus  and  causing 
many  of  them  to  appear  pear-shaped. 

Bull  8,  Fig.  117.  Two-year-old.  Since  first  used,  June 
15,  1919,  has  shown  poor  fertility.  Has  served  twenty-seven 
cows,  with  thirty-six  copulations.  This  resulted  in  six 
(23.2  per  cent,  of  cows  bred,  16.7  per  cent,  of  copulations) 
conceptions,  none  of  which  has  terminated.  Physical  ex- 
amination revealed  a  slight  granular  balanitis  and  small 
vesiculae  seminales,  which  were  apparently  slightly  ar- 
rested in  development.  Three  to  five  mils,  (which  is  less 
than  normal  yield)  of  normal-appearing  semen  were  ob- 
tained on  two  occasions.  Degeneration  of  the  cell  was  in- 
dicated by  a  lack  of  definition  between  the  cytoplasmic  and 
nuclear  elements.  In  some  cells,  the  nuclear  membrane 
presented  a  concavity  instead  of  the  normal  convexity  pro- 


The  General  Infections  of  the  Genital  Organs  of  Cattle      37  i 

jecting  into  the  cytoplasmic  portion.  Many  of  the  cells  ap- 
peared about  normal.  Some  of  the  cells  were  too  large; 
they  might  be  termed  megalocephalic. 

Bull  9,  Fig.  118.  Seven-year-old.  Has  served  twenty- 
seven  cows — twenty-nine  recorded  copulations  with  eight 
(29.6  per  cent.)  conceptions  resulting.  Physical  examina- 
tion revealed  bilateral  seminal  vesiculitis.  Ten  to  twelve 
mils,  of  semen  of  normal  appearance  were  obtained.  It  con- 
tained numerous  short-chained  streptococci  on  smear.  The 
spermatozoa,  all  parts  of  which  showed  in  clear  detail,  were 
apparently  normal. 


Fig.  iiS — Spermatozoa  from  Bull  No.  9. 

Cells  apparently  normal,  but  semen  contained  sliort  streptococci. 

Bull  10.  Three-year-old.  Has  been  in  present  herd  two 
and  one-half  years.  Total  number  of  cows  served,  fifty, 
with  ninety-one  copulations  resulting  in  thirty-four  concep- 
tions in  twenty-nine  cows  (two  conceptions  each  in  five 
cows),  of  which  six  aborted.  Since  October  22,  1919,  there 
have  been  eleven  copulations  with  eight  cows,  and  no  concep- 


37^ 


Diseases  of  the  Genital  Organs 


tions.  Twenty-one  of  the  cows  (42  per  cent.)  served  did 
not  conceive.  Examination  of  cows  revealed  little  cause  for 
sterility.  Examination  of  bull  revealed  presence  of  seminal 
vesiculitis  on  left  side.  Organs  and  erection  normal  but, 
owing  to  the  custom  of  placing  cows  for  service  with  their 
hind  parts  raised,  half  an  hour  to  an  hour  was  often  re- 
quired to  serve  a  cow,  leading  to  an  increased  strain  on  the 
genital  apparatus,  which  may  have  been  a  potent  factor  in 


Fig.   119. — Spermatozoa  from  Bvill  No.  11. 
Cell  heads  stained  poorly, because  the  nuclear  nieuihrane  was  imperfect. 

the  production  of  the  spermato-cystitis  and  decreased  fer- 
tility. Owing  to  unfavorable  conditions  for  coitus.  I  was 
unable  to  get  a  sample  of  semen. 

Bull  11,  Fig.  119.  Four-year-old.  Has  served  sixty-two 
cows,  with  a  total  of  one  hundred  and  seven  copulations, 
resulting  in  twenty-nine  conceptions  and  eleven  (37.9  per 
cent.)  abortions.  From  the  first  his  fertility  has  been  low. 
Twenty-eight  cows  served  by  this  bull  (45.1  per  cent.)  sub- 
sequently conceived  from  service  by  another  bull. 


The  Getieral  Infections  of  the  Genital  Organs  of  Cattle     373 

Examination  revealed  bilateral  spermatocystitis,  with 
other  portions  of  the  genital  apparatus  normal.  Organs 
excellent  but  copulation  interfered  with  by  considerable 
pain  on  erection,  evidently  due  to  the  sensitiveness  of  the 
seminal  vesicles.  About  ten  mils,  of  apparently  normal 
semen  were  obtained,  containing  sperm  cells  of  low  motility. 
Firm  coagulum  appeared  within  a  few  minutes.  The  head 
parts  did  not  stain  well.  The  nucleus  stained  poorly.  The 
nuclear  membrane  was  not  well  defined. 

The  inefficiency  of  Bull  11  was  so  marked,  especially  in 
contrast  to  other  sires  used  in  the  herd,  that  his  slaughter 
was  found  advisable.  Laboratory  examination  of  the  or- 
gans, including  testicles,  epididymes  and  seminal  vesicles, 
revealed  no  macroscopical  lesions.  Cultures  and  smears 
from  these  organs  were  negative.  The  sterility  appeared 
entirely  referable  to  the  changes  occurring  in  the  germinal 
cells.  The  infection  in  the  female  was  probably  not  specific, 
but  merely  the  result  of  lowered  resistance  or  a  predisposi- 
tion on  the  part  of  the  embryo  to  those  organisms  of  low 
vitality  which  ordinarily  inhabit  the  female  genital  tract. 

Sterility  of  the  bull  may  be  directly  due  to  conditions  af- 
fecting his  general  health,  but  is  more  frequently  referable 
to  demonstrable  pathologic  conditions  occurring  either  in 
the  germinal  cells  or  in  the  glandular  structures  of  the  geni- 
tal system.  These  changes  may  or  may  not  be  accompanied 
by  recognizable  infection.  The  diversity  of  the  bacteriologi- 
cal findings  of  the  genital  glands  and  of  the  semen  do  not 
clearly  indicate  the  presence  of  a  specific  type  of  infection. 
A  streptococcus  of  the  viridans  type  is  most  frequently 
found.  In  the  female  genital  organs  of  one  herd  which  has 
been  subjected  to  numerous  bacteriological  studies,  appar- 
ently this  organism  predominates.  In  this  herd  the  ovi- 
ducts are  most  seriously  involved.  This  usually  follows 
cervicitis  which  yields  to  treatment,  while  the  tubal  disease 
defies  all  efforts  at  control.  The  bull  is  apparently  an  im- 
portant, if  not  the  chief  factor  in  bringing  about  these  con- 
ditions. 

It  is  common  to  find  morphological  changes  in  the  sperma- 


274  Diseases  of  the  Genital  Organs 

tozoa.  These  occur  mainly  as  abnormal  development  or  ar- 
rest in  development.  Quite  frequently  I  have  seen  extremely 
large  spermatozoan  heads  (megalocephalia)  which  so  far  as 
determined  are  otherwise  normal.  Abnormally  small  heads 
appear  with  much  greater  frequency.  Morphological  altera- 
tion in  any  considerable  proportion  of  the  spermatozoa  defi- 
nitely decreases  the  procreative  capacity  of  the  bull.  The 
germinal  cell  may  also  be  of  low  vitality  without  showing 
morphological  deviations.  It  is  a  well  demonstrated  fact 
that  the  vitality  of  some  bulls  is  so  lowered  that  a  healthy 
vigorous  calf  is  rarely  produced.  The  cause  for  this  may 
be  an  inherent  weakness,  the  devitalizing  effect  of  a  general 
constitutional  disturbance,  or  a  local  inflammation  of  the 
germinal  epithelium. 

My  studies  of  numerous  herd  sires  bring  out  many  in- 
teresting problems.  Since  it  has  become  my  regular  prac- 
tice to  examine  the  semen  of  bulls  in  herds  where  there  is 
a  high  rate  of  abortion,  I  have  been  interested  to  find  that 
the  spermatozoa  almost  always  show  marked  pathologic 
changes.  I  have  not  as  yet  been  able  to  correlate  such 
changes  with  any  specific  infection.  From  results  thus  far 
obtained,  it  appears  unsafe  to  conclude  that  abortions  oc- 
curring in  a  herd  are  due  to  a  specific  disease  of  the  female, 
chiefly  or  alone,  if  the  sire  is  not  first  subjected  to  a  thor- 
ough examination. 

Although  it  has  been  impossible  to  work  out  all  data  on 
bulls  examined  up  to  the  present  time,  the  results  so  far  in- 
dicate : 

(1)  that  sterility  of  varying  degrees  in  bulls  is  very  com- 
mon, 

(2)  that  such  sterility  is  associated  commonly  either  with 
an  arrest  in  the  development  of  the  sperm  cell  or  with  dis- 
integration after  reaching  maturity, 

(3)  that,  as  the  sterility  is  accompanied,  in  a  large  pro- 
portion of  the  cases  so  far  studied,  by  spermato-cystitis, 
with  no  atrophic  orchitis,  it  appears  that  the  destruction  or 
devitalization  of  the  spermatozoa  is  due  to  the  toxic  sub- 
stances derived  from  bacterial  infection, 


Degeyierative  Orchitis  of  Calves  375 

(4)  that  such  infection  is  present,  not  only  in  the  semi- 
nal vesicles,  but  also  in  the  seminiferous  tubules  and  epidi- 
dymes, 

(5)  that  the  determination  of  the  motility  of  spermato- 
zoa does  not  constitute  a  reliable  standard  for  the  measure- 
ment of  their  vitality  and  powers  of  fecundation, 

(6)  that  some  outbreaks  at  least  of  the  so-called  contag- 
ious abortion  are  entirely  referable  to  a  lessened  vitality  of 
the  spermatozoa. 

A.     Orchitis 

1.    Degenerative  Orchitis  of  Calves.    Destruction  of 

Spermatogenetic  Epithelium  in  Calves.    Arrest 

IN  Development  of  Scrotal  Testes. 

Desquamative  Orchitis 

There  occur  not  infrequently  cases  of  absolute  sterility  in 
young  bulls,  which  reveals  itself  immediately  when  the  ani- 
mal is  put  into  service.  The  general  condition  of  the  bull 
may  be  beyond  criticism.  He  is  distinctly  masculine  in  his 
head,  neck,  and  voice  and  shows  normal  sexual  desire.  He 
copulates  comparatively  promptly  but,  observed  closely,  is 
seen  to  ejaculate  slowly  and  in  a  manner  to  raise  doubt. 
After  copulation,  little  or  no  semen  can  be  recovered  from 
the  vagina.  Microscopic  search  shows  the  total  absence  of 
spermatozoa. 

Clinical  examination  of  the  testicles  shows  them  to  be 
small  and  flaccid.  The  two  glands  are  symmetrical  and  one- 
fourth  to  three-fourths  the  normal  volume. 

Histologically,  the  epithelium  of  the  tubuli  seminiferi  has 
disintegrated  and  the  tubuli  contain  detritis.  Spermatozoa 
are  absent.  Ordinarily  there  remains  but  a  single  epithelial 
layer  on  the  basement  membrane  of  the  tubule.  A  few  im- 
perfect spermatozoa  or  spermatoids  may  be  present  in  the 
cellular  debris  in  the  lumen  of  the  tubules.  The  tubules  of 
the  epididymis  participate  in  the  epithelial  destruction. 

The  degenerative  changes  are  evidently  of  bacterial  ori- 
gin, but  the  form  of  bacteria  has  not  been  studied.  The  de- 
structive changes  appear  to  be  quite  analogous  to  those  oc- 
curring in  the  oviducts,  in  which  streptococci  of  the  veri- 


376  Diseases  of  the  Crcnital  Organs 

dans  type  predominate.     The  B.  abortus  of  Bang   is  not 
known  to  participate  in  the  destruction. 

The  clinical  diagnosis  appears  to  be  simple  and  clear,  but 
the  subject  deserves  further  study.  When  discussing  "Ar- 
rests in  Development  of  Scrotal  Testes,"  I  have  referred  to 


Fic.    121— Degenerative,  or  Desquamative  Orchitis  in  Young  Bull. 

^,  Normal   testis  of  l)iill  ;    />',  .Ic^i'iuTativu    testis  of  sU-iik- hull  ;   /,  testis; 
2,  head  of  ei)i(li(iyiiiis  ;  j,  body  of  ei)ididymis  ;    /,  .^lohus  minor. 

the  clinical  characters  here  described.  The  glands  have 
much  the  consistency  of  cryptorchid  testicles,  in  which  the 
arrest  in  development  is  assumed  to  be  purely  embryologic, 
unassociated  with  infection.  Possibly  such  arrests  occur  in 
scrotal   testes   without   infection,   but   this   is   improbable. 


Degenerative  Orchitis  of  Calves  2)11 

Cryptorchid  testicles  based  upon  embryologic  arrest  are  al- 
most invariably  much  smaller  in  volume  than  in  the  condi- 
tion under  discussion.  It  appears  highly  probable  that  in 
all,  or  virtually  all  scrotal  testicles  of  the  type  described  the 
changes  are  referable  to  bacterial  invasion.  The  period  of 
invasion  appears  to  be  that  of  the  nursery.  At  least  the  era 
of  invasion  precedes  puberty,  so  that  from  the  first  copula- 


FiG.  122— Degenerative  (Atrophic;!  Orchitis  in  Young-  Bull. 

/,  Normal  testis  ;   2,  atrophic  degenerate  testes  ;   j,  body  of  atrophic  gland  ; 

4,  head  and,  5,  tail  of  epididymis  ;    6,  scrotal  peritoneum  turned  back, 

showing  adhesions  to  testicular  peritoneum. 

tion  the  animal  is  absolutely  unfertile.  The  invasion  may 
be  intra-uterine,  but  this  appears  doubtful.  The  bacterial 
invasion  of  living  bovine  fetuses  is  commonly  restricted,  so 
far  as  determined,  to  the  alimentary  tract.  Perhaps  it 
w^ould  be  more  accurate  to  term  the  presence  of  bacteria  in 
the  fetal  alimentary  canal  as  bacterial  "inclusion"  rather 
than  "invasion."  That  is,  the  bacteria  from  the  utero- 
chorionic  cavity  of  the  coyv  invade  the  amniotic  fluid  by 


378  Diseases  of  the  Ceyiital  Organs 

penetrating  the  chorion  and  are  then  swallowed  by  the  em- 
bryo in  the  constant  physiologic  process  by  which  the  fetus 
swallows  its  amniotic  fluid.  When  the  ingested  amniotic 
fluid  is  absorbed,  the  contained  bacteria,  with  cellular  de- 
bris, remains  as  a  filtrate  to  constitute  the  meconium.  Nor- 
mally the  bacteria,  once  imprisoned  in  the  meconium,  re- 
main so  permanently  and  are  expelled  as  a  component  part 
of  it  by  the  new-born  calf.  Aborts,  which  commonly  suf- 
fer from  dysentery  prior  to  their  death  and  expulsion,  are 
subject  to  general  bacterial  invasion.  The  heart  blood  of 
the  fetus  may  contain  the  same  bacteria  as  the  utero-chori- 
onic  space  of  the  mother.  This  also  appears  to  be  true  at 
times  of  prematurely  born  calves  or  of  very  sick  calves  born 
at  the  completion  of  the  normal  duration  of  pregnancy,  but 
these  ordinarily  succumb  to  disease  (calf  sepsis,  calf  scours, 
calf  pneumonia).  The  infection  probably  occurs  most  fre- 
quently soon  after  birth,  while  the  digestive  or  respiratory 
epithelium  is  damaged  or  destroyed  as  a  result  of  dysentery 
or  pneumonia,  or  in  the  presence  of  a  lesser  degree  of  diges- 
tive or  pulmonary  disturbance. 

The  condition  presents  an  interesting  problem  in  the 
ethics  of  the  sale  of  pedigreed  bull  calves  for  breeding  pur- 
poses. I  have  not  known  a  breeder  to  recognize  the  defect 
prior  to  sale  and  believe  that  he  would  not  ordinarily  see  it 
until  his  attention  is  attracted  to  the  condition  by  the  ster- 
ility. The  sale  of  such  animals  is,  therefore,  usually  honor- 
able. When  the  bull  fails  to  breed  and  the  disease  is  recog- 
nized, the  breeder  is  usually  equally  honorable  in  making 
prompt  retribution.  In  one  instance,  however,  where  a 
young  bull  was  sold  at  a  very  high,  perhaps  exorbitant 
price,  the  seller  refused  to  make  restitution.  The  case  was 
brought  into  court.  There  was  no  written  warranty,  but 
the  statutes  of  the  state  where  the  sale  was  made  hold  that 
the  purpose  for  which  an  article  is  sold  carries  with  it  an 
implied  warranty  of  fitness  for  the  use  for  which  the  article 
is  purchased.  The  contention  of  the  defendant  was  that  the 
shipment  of  the  bull  from  the  Atlantic  to  the  Pacific  Coast 
in  a  common  box-car  had  caused  a  degeneration  of  the  tes- 


Orchitis  iyi  Adult  Bulls  37  9 

tides  as  a  result  of  the  vibration  of  the  car.  He  supported 
the  plea  by  the  evidence  of  numerous  veterinarians  with 
such  success  as  to  cause  a  mis-trial  of  the  case. 

The  condition,  once  established,  is  evidently  beyond  rem- 
edy. If  my  view  of  its  origin  is  correct,  it  can  generally,  if 
not  always,  be  prevented  by  the  proper  handling  of  young 
calves. 

2.    Orchitis  in  Adult  Bulls 

I  have  not  observed,  and  have  not  found  described  in  adult 
bulls  a  degenerative  orchitis  with  desquamation  of  the 
spermatogenetic  epithelium  with  flaccidity  of  the  testicle, 
as  described  above  in  bull  calves.  This  is  probably,  if  not 
certainly,  due  to  the  absence  of  careful  study.  It  would  be 
difficult  to  assume  that  bacteria  causing  the  destruction  of 
the  spermatogenetic  cells  in  calves  may  not  also  invade  and 
cause  similar  injury  to  the  adult  testicles.  There  would  be 
differences,  however,  in  the  results  from  the  invasions  at 
two  separate  epochs.  Doubtless  there  is  a  difference  of  re- 
sistance. The  essentials  are  that  there  shall  be  a  type  of 
organism  which  may  invade  the  tubuli  seminiferi  and  cause 
a  slow  disintegration  of  their  lining  cells  without  arousing 
the  classic  signs  of  inflammation,  "heat,  pain,  redness  and 
swelling,"  and  impotent  to  cause  abscessation  or  total  ne- 
crosis. 

Clinical  data  are  at  hand  which  warrant  the  tentative 
conclusion  that  such  degenerative  or  desquamative  orchitis 
exists  frequently  and  is  serious.  Some  bulls  demonstrate 
moderate  fertility  at  the  commencement  of  their  breeding 
career,  but  show  upon  close  study  a  slowly  advancing,  in- 
sidious sterility.  At  first  the  difficulty  is  ascribed  to  the 
cows.  The  bull  appears  well,  has  normal  sexual  desire,  and 
copulates  eagerly.  In  large  herds  where  several  sires  are 
kept,  a  comparative  study  of  his  breeding  shows  him  to  be 
less  fertile  than  other  bulls  under  analogous  conditions. 
Further  study  reveals  the  fact  that  his  pregnancies  are  less 
secure,  so  that,  while  the  general  rate  of  observed  expulsion 
of  fetal  cadavers  is,  for  example,  10  per  cent.,  his  rate  is  20 


38o  Diseases  of  the  Cenital  Organs 

or  25  per  cent.  In  many  cases  the  fertility  appears  inter- 
mittent. For  a  brief  period  all  copulations  fail;  then  follows 
a  period  of  fair  fertility.  If  the  semen  is  examined,  inter- 
esting changes  are  found  in  the  spermatozoa. 

In  this  inadequately  studied  field,  the  best  that  can  at 
present  be  done  is  to  study  the  spermatozoa,  their  degree  of 


Fig.  123— Purulent  Periorchitis  (  Knipvenia  of  Scroluin)  with 
Necrosis  and  Atrophy  of  Testes. 
I     Vestige  of  testis  sectioned,  showiii.','    on   the    ri.uht  remnant    of  paren- 
chyma ;    2,  epididymis  ;     ?,    vas  deferens  ;  4.  scrotal  wall  turned  back.     On 
the  right  of  the  right-hand  fignre  the  broad  white  streak  between  2  and  .; 
is  a  deep  inci.sion  made  to  keep  specimen  open. 

the  sperm  heads.  If  spermatozoa  are  abundant  but  all 
dead,  the  tubuli  seminiferi  must  be  comparatively  sound 
and  death  has  occurred  somewhere  in  the  excretory  appara- 
motility,  the  frequency  of  the  separation  of  heads  and 
bodies,  and  the  staining  characteristics,  size,  and  form  of 
tus.  If  the  spermatozoa  are  scant  and  marked  disintegra- 
tion has  occurred,  it  would  appear  that  the  damage  may 


Orchitis  in  Adult  Bulls 


381 


_   &i  o 


11 

o  .^ 


i£' (u 


OJ 


.  •  a  "^ 


382  Diseases  0/  the  Genital  Organs 

have  taken  place  within  the  tubuli  seminiferi.  If  no  sper- 
matozoa are  present  in  the  semen,  it  follows  that  the  excre- 
tory ducts  are  blocked  or  that  the  spermatogenetic  epithe- 
lial cells  are  destroyed.  So  far  as  known,  the  blocking  of 
the  excretory  ducts,  as  in  cases  of  epididymitis  or  epididy- 
mal  abscess,  is  recognizable  upon  physical  examination. 

Severe  orchitis,  not  common  in  bulls,  ordinarily  termi- 
nates in  abscessation.  Very  rarely  it  appears  as  an  en- 
zootic. 

Wallraff  (Repertorium  der  Tierheilkunde,  1846,  p.  219) 
records  an  outbreak  of  purulent  orchitis  in  horses,  cattle 
and  goats.  The  disease  had  existed  in  his  locality  in  Freu- 
denstadt  for  a  number  of  years.  At  least  it  was  known  in 
1832,  fourteen  years  prior  to  the  date  of  his  contribution. 
For  a  year  prior  to  his  report,  the  disease  had  been  very 
common  and  caused  a  very  considerable  loss  among  breed- 
ing bulls.  It  involved  animals  of  all  ages,  attacking  many 
calves  when  only  10  to  20  days  old.  The  disease  began  with 
light  fever  and  loss  of  appetite.  The  animals  stamped  their 
hind  feet  as  if  afflicted  with  colic.  Presently  the  testicles 
became  more  or  less  swollen,  the  scrotum  red,  hot,  and 
painful  upon  manipulation.  This  condition  continued  from 
three  to  five  days.  Then,  upon  one  or  both  sides  of  the  scro- 
tum, a  small  opening  appeared,  from  which  at  first  a  stink- 
ing discharge,  mixed  with  blood,  escaped.  After  one  or  two 
days  this  discharge  was  superseded  by  ordinary  pus.  This 
continued  for  five  to  fourteen  days,  until  the  testicle  was 
wholly  destroyed.  Wallraff  uniformly  observed  the  swell- 
ing and  suppuration  in  the  left  testicle  first.  As  a  general 
rule,  after  one  testicle  was  destroyed,  the  other  also  under- 
went destruction  later,  though  in  some  cases  one  of  the  tes- 
ticles escaped. 

The  disease  had  little  danger  for  the  life  of  the  animal. 
After  the  destruction  of  the  testicle,  the  animal  recovered 
without  any  very  great  enlargement  of  the  scrotum.  In 
one  case,  when  the  abscess  in  the  testicle  ruptured,  the  bull 
almost  bled  to  death.  Wallraff  failed  to  recognize  the 
cause.     For  a  time  he  thought  it  was  hereditary,  and  con- 


Orchitis  in  Adult  Bulls  383 

tinued  to  believe  that  it  might  be  so.  However,  he  found 
that  sound  males  introduced  from  other  sections,  where  the 
disease  was  unknown,  contracted  the  malady,  and  conse- 
quently felt  that  there  must  be  a  local  infection  of  some 
kind. 

While  there  seemed  to  be  no  great  danger  to  the  life  of 
the  patient,  there  was  very  serious  loss  in  condition  and  also, 
in  all  or  nearly  all  the  cases,  the  breeding  life  of  the  animal 
was  brought  to  a  close.  Consequently,  as  a  rule,  when  the 
disease  was  observed  early,  the  animal  was  sent  to  the 
butcher  as  the  most  economic  course.  Once  the  disease  was 
established,  castration  apparently  proved  the  most  direct 
method  of  handling. 

There  is  no  very  clear  line  of  demarcation  clinically  be- 
tween orchitis  and  epididymitis.  The  symptoms  are  funda- 
mentally alike.  The  tumefaction  of  one  structure  quickly 
encroaches  upon  the  other  and  the  two  organs  blend.  Com- 
monly also  the  disease  processes  in  orchitis  and  epididymitis 
blend,  so  that  one  is  rarely  present  without  the  other. 

Orchitis  ordinarily  reveals  itself  by  a  more  or  less  pro- 
nounced swelling  of  the  testicle.  As  a  general  rule,  the  dis- 
ease is  unilateral  in  the  bull,  there  being  no  commonly  known 
acute  systemic  infection  which  tends  to  involve  simultane- 
ously both  the  glands,  as  observed  in  the  infectious  cellulitis 
of  horses.  When  orchitis,  due  to  infection,  causes  definite 
changes  in  the  gland  itself,  they  usually  occur  very  promptly, 
with  much  swelling  and  pain.  As  a  rule,  there  is  loss  of  ap- 
petite with  elevation  of  temperature.  The  very  firm  envel- 
ope or  tunic  of  the  testicle  renders  any  inflammation  of  the 
gland  excessively  painful.  At  the  same  time  it  prevents 
prompt  relief  by  free  swelling  and  tends  to  cause  destruction 
of  the  tissues  as  a  consequence  of  blood  stasis  from  com- 
pression. 

A  common  result  of  orchitis  in  the  bull  is  the  formation 
of  an  abscess  in  which  the  entire  gland,  along  with  the 
epididymis,  undergoes  necrosis  and  purulent  destruction. 
In  the  one  instance  of  abscessation  of  the  testicle  of  the  bull 
in  the  college  collection,  the  abscess  has  attained  a  diameter 


'384  Diseases  of  the  Genital  Organs 

of  about  ten  inches.  The  capsule  of  the  abscess,  shown  in 
Fig,  124,  consists  chiefly  of  the  cremaster  muscle  and  its 
fascia.  The  testicle  and  epididymis  have  almost  completely 
disappeared,  though  faint  traces  of  the  necrotic  gland  are 
found  embedded  within  the  pus.  A  few  bands  of  connective 
tissue  pass  across  the  abscess  cavity  from  wall  to  wall. 

The  biology  of  orchitis  in  bulls  has  not  been  determined. 
Erhardt  (Schweizer  Archiv.  fiir  Tierheilkunde,  Vol.  38,  p. 
79)  records  a  case  of  orchitis  in  a  bull  due  to  the  vesicular 
venereal  disease  of  cattle.  Other  writers  also  attribute  cases 
of  purulent  orchitis  in  the  bull  to  the  granular  venereal  dis- 
ease, but  this  view  is  difficult  of  verification  because  the 
biology  of  the  malady  is  unknown.  So  far  as  known,  the 
B.  abortus  of  Bang  plays  little  or  no  part  in  the  causation 
of  orchitis. 

Necessarily  the  prognosis  of  orchitis  is  highly  unfavora- 
ble. As  a  general  rule,  when  the  infection  is  so  severe  as  to 
cause  definite  clinical  symptoms,  the  organ  does  not  re- 
cover its  physiologic  function.  The  danger  to  the  life  of 
the  animal  is  not  great. 

The  treatment  of  orchitis  has  not  been  definitely  formu- 
lated. Theoretically  there  might  be  some  justification  in 
local  applications  intended  to  lessen  the  inflammation,  such 
as  ice-packs  or  the  application  of  cold  water,  along  with 
support  by  means  of  a  suspensorium.  Practically  I  have 
not  known  this  plan  to  accomplish  any  good  and  I  doubt 
very  greatly  its  efficiency.  If,  however,  one  has  reason  to 
believe  that  the  orchitis  is  due  to  traumatism,  the  local 
treatment  should  be  applied  and  should  promise  well.  I  am 
not  certain  how  frequently  traumatic  orchitis  occurs  in  do- 
mestic animals.  Many  writers  give  it  a  prominent  place, 
though  upon  what  ground  is  not  perfectly  clear.  Gmelin 
(Handbuch  der  Tieriirztlichen  Chir.  u,  Geburtshilfe.  Bayer 
und  Frohner,  p.  432)  states  that  the  commonest  cause  of 
orchitis  is  traumatism,  but  I  have  not  seen  this  in  any  do- 
mestic animal  save  in  one  case  of  gunshot  wound. 

As  a  general  rule,  as  stated  above,  the  functional  life  of 
the  gland  is  at  an  end.    Whenever  this  mav  be  assumed,  the 


Degenerative  Epididymitis  of  Calves  385 

most  direct  and  radical  method  of  handling  is  castration. 
When  only  one  gland  is  involved,  its  removal  does  not  inter- 
fere with  the  animal's  fertility  and  affords  the  best  and 
promptest  remedy  that  we  possess.  In  castrating  such  an 
animal  it  is  to  be  remembered  that  the  gland  is  generally 
adherent  to  the  parietal  peritoneum  of  the  scrotum  and, 
through  it,  to  the  cremaster  and  its  fascia.  Therefore  it  is 
more  convenient,  as  well  as  less  dangerous,  to  castrate  by 
the  covered  operation.  In  this  operation  the  skin  and  dartos 
are  freely  incised  at  the  lowest  part  of  the  scrotum  and  a 
separation  made  with  the  handle  of  the  scalpel,  or  with  the 
fingers,  between  the  dartos  and  the  cremasteric  fascia  up 
to  the  inguinal  canal.  A  ligature  is  then  applied  to  the 
spermatic  cord  covered  by  the  cremaster  muscle,  and  the 
testicle,  with  its  coverings,  cut  away  an  inch  or  two  beyond 
the  point  of  ligation.  The  ligature  should  preferably  be  of 
heavy  chromatized  catgut  with  a  durability  of  about  twenty 
days. 

B.     Epididymitis 

1.     Degenerative  Epididymitis  of  Calves.     Arrest  in 
Development 

In  the  preceding  article  upon  degenerative  orchitis  in 
calves,  it  has  been  mentioned  that,  when  that  disease  occurs, 
the  epididymis  ordinarily  participates  in  the  pathologic 
changes.  From  what  I  have  been  able  to  observe,  the  epi- 
didymitis is  probably  the  more  important  and  primary 
lesion. 

There  are  no  outstanding  clinical  symptoms  beyond  those 
already  described  under  orchitis.  So  far  as  has  been  ob- 
served, the  calf  as  a  nursling  presents  no  symptoms  which 
attract  any  attention.  This  may  be  due  to  the  fact  that, 
since  the  testicles  of  calves  are  not  observed,  changes  which 
are  perfectly  visible  may  occur  without  being  noted.  When 
the  calf  comes  to  breeding  age,  he  is  found  to  be  sterile  and 
when  examined  critically,  as  already  stated  under  orchitis, 
the  testicles,  with  the  epididymes,  are  found  to  be  small  and 
25 


386  Diseases  of  the  (ieiiital  Orgavs 

soft.  So  far  as  known,  the  disease  is  always  bilateral  and 
apparently  dates  back  to  infection  during  the  nursing  pe- 
riod, as  described  under  orchitis.  The  condition,  which  is 
beyond  remedy,  can  be  prevented  only  by  the  protection  of 
the  young  calf  against  the  inroads  of  infection.  This  will 
be  more  fully  discussed  under  the  infections  of  new-born 
calves. 

2.    Chronic  Indurated  Epididymal  Abscesses  of  Calves 

I  have  observed  one  instance,  in  a  young  bull  of  poten- 
tially great  value,  a  long-standing,  indurated  abscess  in  the 
globus  minor  of  each  epididymis.  The  bull,  well  developed 
in  all  respects,  was  very  vigorous  and  copulated  freely,  but 
was  absolutely  sterile  from  the  beginning.  Physical  exam- 
ination revealed  a  hard  enlargement,  one  inch  or  more  in 
diameter,  in  the  globus  minor  of  each  testicle.  Tuberculosis 
of  the  epididymis  was  suspected,  but  he  failed  to  react  to 
the  tuberculin  test.  One  of  the  glands  was  then  removed 
for  examination.  The  epididymis  was  found  to  contain  a 
small  abscess  with  indurated  walls,  which  had  something 
of  the  appearance  of  a  tubercular  abscess  but  was  without 
calcification,  and  no  tubercle  bacilli  could  be  found.  Later 
the  bull  was  slaughtered  and  the  other  testicle  was  found  to 
be  essentially  identical. 

The  diagnosis  of  chronic  indurated  abscess  of  the  epidid- 
ymis is  comparatively  simple.  So  far  as  we  know,  the  ab- 
scess is  most  liable  to  occur  in  the  globus  minor,  which  in 
the  bull  projects  beyond  the  lower  end  of  the  testicles  on  its 
posterior  surface,  where  it  is  very  readily  palpated.  If  any 
doubt  arises  on  the  part  of  an  inexperienced  examiner,  the 
comparison  of  the  diseased  epididymis  with  that  of  a  healthy 
animal  at  once  reveals  the  great  departure  from  physiologic 
condition.  Both  the  enlargement  and  the  hardness  are  well 
marked  and  not  readily  mistaken  for  anything  else.  Should 
the  abscesses  occur  at  other  points  in  the  epididymis,  they 
are  quickly  recognized  by  the  same  general  symptoms.  The 
head  of  the  epididymis  is  readily  palpated  except  for  the 
covering  of  the  cremaster.  as  shown  in   Fig.  2  on  jiage  5. 


Chronic  Indurated  Epididvnial  Abscesses  of  Calves  387 

The  body  of  the  epididymis  is  not  so  easily  palpated,  as  in- 
dicated in  Figures  3  and  4  on  pages  7  and  8.  If  there  is  any 
material  enlargement,  however,  it  should  be  detected  with- 
out great  difficulty.  When  the  gland  has  revolved  outward, 
as  shown  in  the  right  testicle  of  Fig.  4,  it  is  brought  more 
readily  into  view  and  can  be  more  definitely  palpated. 


Fig.  125— Chronic  Abscessation  of  Epididymis  in  Young-  Bull. 

A,  Normal  testicle  from  sound  bull  ;    H.  diseased  testicle. 

/,  Testicle  ;  2,  body  of  epididymis  ;  j,  tail  of  epididymis  greatly  enlarged  in 

diseased  gland  ;  j',  section  through  epididymis,  showing  pus  in 

the  epididymal  tubes  ;    7,  portion  of  scrotal  wall 

thrown  back  showing  adhesive  bands. 

The  condition  described  above  appears  to  be  closely  re- 
lated to  the  degenerative  epididymitis  already  spoken  of.  It 
appears  quite  evident  that  the  abscessation  occurred  during 
the  nursery  period,  so  that  it  was  well  established  before  the 
bull  had  reached  breeding  age.  Schroeder^  records  an  in- 
stance of  abscessation  of  the  epididymis  in  which  the  B. 

'  Some  Facts  about  Abortion  Disease,  Jour,  of  Ag.  Research,  Vol  9,  19 17, 
P-  15- 


388 


Diseases  of  the  denital  Organs 


abortus  was  recognized.  He  does  not  state,  however,  that 
no  other  organisms  were  present.  He  reaches  the  conclu- 
sion that  the  B.  abortus  was  the  cause  of  the  abscess.  This 
is  not  very  clear.  It  has  not  been  definitely  shown  that  the 
B.  abortus  of  Bang  is  pyogenic  when  injected  into  the  tis- 
sues. We  do  know,  however,  that  it  is  associated  with  sup- 
puration in  the  uterine  cavity.  Whatever  may  be  the  biology 
of  the  disease,  the  prognosis  is  hopeless. 


I'lC.  i2(; — Orcliitis  and  LpididyiiuLis.     Lull. 

yl,  Left  testis  ;  />',  norinal  k-fl  testis  tor  comi)aris()ii  ;   C.  Rij^lit  testis. 

/,  Globus  major  of  epididymis,  greatly  enlarged  and  adherent   to   testis  ; 

J,  4,  tail   of  epididymis  ;    5,    6.   7,    normal  globus  major,  body   and   globus 

minor  of  epididymis  respectively  ;    S,  inflamed  globus  major  ;   <;,    parietal 

scrotal  peritoneum  adherent  to  testicle,  incised  and  turned  back. 

3.    Epididymitis  of  Adult  Bulls 


Epididymitis  develops  occasionally  in  adult  bulls  which 
have  a  histoiy  of  normal  fertility  over  a  somewhat  ex- 


Sperm  a  to  -  Cystitis  389 

tended  period.  Then  without  cause  there  develops,  gener- 
ally very  gradually,  an  increasing  degree  of  infertility.  An 
increasingly  large  percentage  of  the  cows  which  he  serves 
fail  to  conceive.  The  bull  may  be  apparently  vigorous,  both 
physically  and  sexually,  or  there  may  be  hesitancy  or  diffi- 
culty in  coitus.  It  is  not  known,  however,  that  the  epidid- 
ymitis causes  this  hesitancy  or  difficulty,  which  may  be  due, 
so  far  as  is  now  known,  to  other  lesions  existing  at  the  same 
time.  If  the  semen  of  such  a  bull  is  examined,  the  sperma- 
tozoa are  found  largely  or  wholly  dead.  Upon  physical  ex- 
amination, one  or  both  epididymes  are  found  to  be  swollen 
and  tender.  As  in  the  indurated  abscess  of  the  epididymis 
in  the  young  animal,  so  in  the  adult  bull,  the  inflammation 
is  largely  concentrated  in  the  globus  minor.  The  swelling 
is  hard  and  painful  to  the  touch.  The  cause  of  such  epidid- 
ymitis is  unknown,  beyond  the  fact  that  it  is  evidently  due 
to  infection.  No  studies  have  been  made  regarding  the 
character  of  the  infection.  It  probably  differs  greatly  in 
diff"erent  individuals.  It  is  not  generally  pyogenic,  so  far 
as  yet  determined. 

So  far  as  known,  there  is  no  hope  for  recovery  and  noth- 
ing to  advise  in  the  way  of  treatment.  It  is  barely  possible 
that  in  some  cases  one  might  achieve  results  by  the  removal 
of  the  diseased  gland.  However,  there  is  the  constant  dan- 
ger that  the  other  gland  is  similarly,  although  not  palpably 
infected,  in  which  case  the  removal  of  one  gland  would  be 
of  no  avail.  In  other  cases  I  have  found  clinically  that  the 
seminal  vesicle  was  at  the  same  time  similarly  inflamed,  so 
that  no  good  could  be  expected  from  removing  the  diseased 
epididymis  and  testicle  while  the  diseased  seminal  vesicle 
was  allowed  to  remain.  The  only  hope,  therefore,  in  remov- 
ing the  one  gland  is  that  the  opposite  gland  is  sound  and 
that  there  is  no  disease  of  the  seminal  vesicle  or  other 
glands  about  the  pelvic  urethra. 

C    Infections  of  the  Glands  of  the  Pelvic  Urethra 

1.    Spermato-Cystitis.    Semino-Vesiculitis 

Semino-vesiculitis,  or  inflammation  of  the  seminal  vesi- 
cles, has  attracted  scant  attention  in  bulls  or  other  breeding 


390  Diseases  of  the  Genital  Ors;ans 

males.  It  is  therefore  impossible  at  present  to  make  a  re- 
liable estimate  of  the  frequency  of  its  occurrence.  Enough 
study  has  been  given  the  subject  recently  to  show  that 
semino-cystitis  is  neither  rare  nor  unimportant  in  breeding 
bulls. 


Fig.  127 — Purulent  Spermato-Vesiculitis.     Bull.      ( l-"roin  same  animal 

as   l-'igs.  126  and  .S6). 

On  the  kft  is  included  a  normal  i)elvic  urethra,  urinary  bladder, 

and  seminal  bladder  for  comparison. 

/,  /,  Greatly  enlarj^ed  vesiculae  .seniinales  ;    2,  2,  enlar).;ed  terminal  ])ortions 

of  vasa  deferentia  ;    ?,  urinary  bladder  ;    /,   ])elvic   urethra   covered   by 

Wilson's  nuiscle  and  prostate  },dand  ;  5,  body  of  i)rostale. 

The  symptoms  have  not  yet  been  clearly  defined.  In  the 
cases  observed  clinically,  there  was  hesitancy  in  the  ejacu- 
lation of  semen,  and  a  markedly  deficient  volume  of  the 
seminal  fluid.  Taking  into  account  the  present  belief  in 
the  function  of  the  seminal  vesicles,  the  symptoms  thus  far 


Spermato- Cystitis  39  • 

observed  appear  logical  and  inevitable.  In  ruminants, 
swine  and  solipeds,  the  seminal  vesicles  are  the  outstanding 
subsidiary  sex  glands  connected  with  the  pelvic  urethra, 
and  are  believed  to  supply  the  chief  volume  of  the  semen, 
serving  as  a  diluent  in  which  the  spermatozoa,  arriving 
from  the  testicles,  may  swim.  This  facilitates  the  ejacula- 
tion of  the  highly  concentrated  mass  of  spermatozoa.  At 
the  same  time  it  is  believed  that  the  physiologic  secretion 
from  the  vesicles  stimulates  and  energizes  the  spermatozoa, 
rendering  them  more  active. 

In  harmony  with  this  view,  present  studies  show  that 
when  the  vesicles  are  inflamed,  not  only  is  the  ejaculation 
tardy  and  the  volume  of  semen  scant,  but  the  spermatozoa 
are  non-motile  or  feeble.  Spermatozoa  taken  from  the  epi- 
didymis in  a  healthy  animal  are  vigorous.  Hence  it  would 
appear  that  in  semino-vesiculitis  the  vesicular  fluid  from  the 
diseased  organ  devitalizes  the  spermatozoa. 

The  clinical  examination  of  the  bull  reveals,  upon  rectal 
palpation,  enlargement  and  irregular,  nodular  swelling, 
with  extreme  sensitiveness.  The  physiologic  gland,  as 
shown  in  Figs.  5-7,  page  11,  may  be  freely  manipulated 
without  Causing  any  evidence  of  pain  but,  once  it  is  in- 
flamed, the  bull  immediately  winces  upon  the  most  moderate 
pressure.  There  are  few  glands  or  organs  in  the  body  which 
show  such  marked  sensitiveness  when  inflamed  as  do  the 
vesiculae  seminales. 

The  clinical  history  of  semino-cystitis  is  a  progressive,  or 
probably  sometimes  sudden,  sterility.  Cows  fail  to  conceive 
uniformly,  or  there  is  total  sterility.  Naturally  the  cows 
and  heifers  are  examined,  and  no  explanation  for  sterility 
is  discovered.  Therefore,  attention  is  turned  to  the  bull. 
In  one  bull,  the  vesiculitis  was  associated  with  epididymitis, 
presumably  due  to  a  common  cause.  There  appeared  to  be 
also  some  inflammation  of  the  vas  deferens.  The  bull  had 
been  imported  from  England  at  high  cost  for  breeding  some 
very  valuable  heifers.  Seven  were  bred  without  a  concep- 
tion. 

It  is  not  improbable  that  epididymitis  and  semino-cystitis 


392 


Diseases  of  the  Genital  Organs 


are  commonly  associated,  but  whether  the  epididymitis  is 
the  progenitor  of  the  cystitis,  or  vice  versa,  there  is  no  evi- 
dence to  show.  Thus  far  the  affection  has  been  chiefly  ob- 
served in  young  bulls,  but  most  bulls  are  young.  There 
seems  quite  a  probability,  however,  that  the  infection,  like 
epididymitis,  is  largely  an  invasion  during  the  nursery  pe- 
riod, and  that  it  lies  somewhat  dormant  until  unfavorable 
hygienic  conditions,  close  confinement,  overfeeding,  or  ex- 
cessive coitus  arouse  the  infection  to  destructive  virulence. 
On  the  other  hand,  the  possibility,  if  not  probability,  of  ac- 
quiring the  infection  through  repeated  coitus  with  highly 
infected  cows,  must  be  frankly  acknowledged  and  the  proper 
hygienic  handling  of  bulls  maintained  in  order  to  anticipate 
such  disease. 

Neglect  of  the  study  of  the  genital  infections  of  bulls  ren- 
ders it  impossible  to  speak  with  any  assurance  regarding 
the  bacteriology  of  semino-vesiculitis.  Buck  and  others, 
searching  the  vesiculae  seminales,  vasa  deferentia.  epididy- 
mes  and  testes  of  37  out  of  a  group  of  235  bulls,  for  the  B. 
abortus,  recognized  that  organism  in  the  vesiculae  seminales 
of  4.  There  appears  nothing  in  their  communication  to  in- 
dicate that  they  were  interested  in  the  bacteriology  of  the 
organ.  Evidently  they  searched  merely  for  the  one  organ- 
ism, ignoring  all  others.  While  they  recognized  the  B.  abor- 
tus in  bulls,  they  have  not  stated  that  the  cystitis  was  due  to 
that  bacterium.  The  B.  abortus  probably  plays  a  negligible 
part  in  the  causation.  Vesicles  from  bulls,  slaughtered  be- 
cause of  sterility  but  not  showing  evident  enlargement,  sub- 
mitted to  Carpenter,  revealed  a  streptococcus.  It  would 
normally  be  suspected  that  the  infections  of  the  vesiculae 
seminales  and  epididymes  would  be  analogous  to  those  of  the 
oviducts,  in  which  streptococci  appear  to  be  the  commonest 
offenders. 

The  prognosis,  from  the  standpoint  of  reproduction,  is 
highly  unfavorable.  It  seems  improbable  at  present  that, 
once  well  established,  semino-cystitis  can  recover,  although 
further  observation  may  modify  such  a  view. 

There  is  no  effective  method  known  for  handling  thi>  dis- 


Balanitis.       Balano-PostJiitis  393 

ease.  It  is  beyond  the  reach  of  the  surgeon.  It  is  not  known 
that  any  internal  disinfectant  can  efficiently  reach  the  or- 
gan. With  the  bacteriology  virtually  undetermined,  vac- 
cines, bacterins,  and  other  biologic  products  can  not  be  ad- 
vocated. The  most  that  can  be  suggested  thus  far  is  sexual 
rest  and  good  general  hygiene  with,  as  a  rule,  eventual 
slaughter. 

2.    Diseases  of  the  Prostate  and  Cowper's  Glands 

The  pathology  of  the  prostate  glands  of  animals  has  not 
been  studied  except  in  the  dog,  where  apparently  the  gland 
suffers  frequently  from  disease.  While  the  gland  is  an  ex- 
tensive one  in  the  bull,  it  is  so  enveloped  by  Wilson's  muscle 
that  it  is  not  directly  palpable.  There  is  nothing  in  veteri- 
nary literature  indicating  to  what,  if  to  any  appreciable  ex- 
tent the  prostate  of  cattle  becomes  diseased. 

In  the  bull  Cowper's  glands  lie  deeply  buried  beneath  the 
ischio-cavernosus  muscles,  where  they  are  not  palpable  un- 
less enormously  enlarged.  I  find  no  record  of  disease  in 
them. 

D.     Balanitis.     Balano-Posthitis 

In  Chapter  XII,  under  'The  Nodular  Venereal  Disease," 
balanitis  and  balano-posthitis  have  been  quite  fully  discussed 
as  one  of  the  practically  universal  results  of  that  infection 
or  lesion  in  ruminants  and  swine.  While  other  infections 
(aside  from  tuberculosis  and  actinomycosis)  may  invade 
these  parts,  they  offer  nothing  of  special  interest  so  far  as 
is  known  at  present.  The  general  principles  of  control  in- 
dicated for  the  nodular  venereal  disease  are  applicable  to 
any  infections  of  a  general  character  which  may  be  added 
to  or  associated  with  it. 


394  Diseases  of  the  Genital  Orgaris 

II.    GENERAL  INFECTIONS  OF  THE  GENITAL 
ORGANS  OF  HEIFERS  AND  COWS 

A.   Diseases  of  the  Ovaries.       Ovaritis 

Simple  ovaritis,  or  oophoritis,  is  not  often  clearly  distin- 
guishable as  a  clinical  entity  in  animals.  In  the  preceding 
chapter  the  invasion  of  the  ovary  by  such  infections  as  ac- 
tinomycosis and  tuberculosis  has  been  recorded.  Rarely 
also  one  encounters  abscessation  of  the  ovary. 

The  diseases  of  the  ovaries  of  cattle  (and  other  animals) 
have  not  been  scientifically  studied.  A  few  very  superficial 
histo-biologic  studies  have  been  begun,  but  abandoned  be- 
fore any  material  knov^ledge  was  gained  or  any  correlation 
between  the  findings  and  clinical  observations  established. 
Much  has  been  written  concerning  the  clinical  aspects  of 
ovarian  diseases.  Between  these  two  fields  of  study  are  the 
m'acroscopical  findings  upon  post-mortem  examination.  The 
knowledge  of  ovarian  diseases  (and  the  diseases  of  other 
genital  organs  may  well  be  included  in  the  generalization) 
is  consequently  superficial  and  fragmentary.  Therefore  any 
statements,  aside  from  the  few  clearly  demonstrated  facts 
which  may  be  presented,  are  to  be  accepted  with  very  liberal 
reservations  and  it  must  be  confidently  expected  that  ade- 
quate study  will  modify  numerous  assumptions  and  beliefs. 

In  general  it  appears  that  the  ovaries  of  cattle  are  fre- 
quently the  habitat  of  varieties  of  infection  of  a  type  which 
may  exist  indefinitely  in  the  gland  without  causing  notable 
disease  but  which  may,  under  certain  conditions,  acquire  a 
force  competent  to  bring  about  disturbances  in  structure 
and  function.  Bacteria  (micrococci,  streptococci,  etc.)  are 
found  in  the  ovaries  of  heifer  calves  and  of  aged  cows,  with- 
out evidence  or  suggestion  that  the  infection  in  the  ovary  of 
the  aged  cow  did  not  acquire  its  ovarian  habitat  while  the 
animal  was  yet  in  the  nursery.  Many  clinical  and  post- 
mortem changes  are  seen  in  the  ovaries,  so  associated  with 
disturbances  of  ovarian  function  as  observed  clinically  that 
certain  conclusions,  assumptions,  or  surmises  are  justified. 


Atretic  Follicles  395 

1.    Atretic  Follicles 

There  are  commonly  observed  in  the  ovaries  of  heifer 
calves,  heifers,  and  cows  numerous  small  cysts,  varying 
from  1/16  to  14  inch  in  diameter,  containing  a  clear  liquid. 
They  appear  to  be  the  remnants  of  follicles  in  which  the 
primitive  or  permanent  ova  have  perished  and  the  follicular 
liquid  has  persisted,  with  more  or  less  addition  to  its  volume. 
I  have  stated  that  they  grow  as  large  as  i/4  inch  in  diameter. 
How  much  larger  they  may  grow  is  at  present  difficult  to 
state.  They  may  grow  much  larger  but,  should  they  do  so, 
become  confused  with  cysts  of  other  origin  and  lose  their 
identity.  That  is,  when  a  larger  cyst  is  encountered  and 
neither  clinical  nor  histological  evidences  of  origin  are 
forthcoming,  accurate  differentiation  is  impracticable. 

The  significance  of  these  small  cysts  is  unknown.  If 
they  elaborate  important  secretions  (endocrines)  or  in  any 
other  manner  modify  the  sexual  functions,  or  if  they  aflfect 
in  any  way  the  reproductive  functions,  the  fact  has  not 
been  demonstrated.  They  are  quite  as  numerous  in  ovaries 
which  function  normally  as  in  those  which  do  not. 

2.    Cystic  Degeneration  of  the  Ovisacs.    Nymphomania 

There  occurs  in  all  species  of  domestic  animals,  though 
preeminently  in  the  cow,  a  type  of  cystic  degeneration  of 
the  ovaries  accompanied  by  nymphomania.  So  far  as  can 
be  determined  at  present,  the  degeneration  is  one  involving 
the  unruptured  ovisacs.  Apparently  this  undergoes  dis- 
tension, the  follicular  liquid  becomes  enormously  increased, 
the  ovum  perishes,  and  there  is  little  tendency  for  the  cystic 
follicle  to  rupture  and  recover  spontaneously. 

It  would  appear  quite  certain  that  the  cystic  disease  is 
one  of  the  ovisac  itself,  because,  so  far  as  I  have  been  able 
to  determine,  there  is  never  any  lutein  tissue  in  the  cyst 
wall.  In  nearly  all  adult  ovaries  there  are  vestiges  of  cor- 
pora lutea,  but  in  nymphomania  they  are  purely  vestigial 
and  are  not  connected  with,  or  visibly  related  to  the  cysts. 

I  have  not  known  nymphomania  to  develop  in  a  pregnant 
animal.     There  are  large  and  small  cysts  in  the  ovaries  of 


396  Diseases  of  the  CnnHal  Organs 

pregnant  cows,  but  not  of  the  nymphomaniac  type.  The 
cysts  of  nymphomania  develop  at  times  when  physiologically 
the  animal  should  ovulate.  That  is,  she  has  reached  breed- 
ing age  and  is  not  at  the  time  pregnant.  No  corpora  lutea 
are  present  to  exclude  estrum.  There  are  no  recognizable 
lesions  in  the  genital  tract  or  elsewhere  which  would  tend  to 
inhibit  estrum,  except  the  nymphomaniac  cysts  themselves. 
It  appears  justifiable,  therefore,  to  believe  that  the  nympho- 
maniac cyst  is  a  pathologic  process  occurring  in  an  ovisac 
which  is  nearing  maturity. 

The  cysts  of  nymphomania  are  exceedingly  variable  in 
size.  They  are  rarely  less  than  one  inch,  and  with  equal 
rarity  exceed  three  inches  in  diameter.  When  larger  cysts 
appear,  like  those  desiribed  on  page  257,  nymphomania  is 
not  present,  and  as  a  rule  the  cyst  inhibits  fertility  upon  the 
iTivolved  side  only,  while  the  other  ovary  functions  and  the 
animal  breeds.  When  the  cyst  of  nymphomania  is  present, 
however,  fertility  is  in  abeyance. 

The  number  of  nymphomaniac  cysts  which  may  simulta- 
neously exist  varies  from  one  to  three  or  four.  The  pres- 
ence of  one  nymphomaniac  cyst  does  not  prevent,  nor  tend 
to  prevent,  the  formation  of  others.  The  cysts  are  multiple, 
not  multilocular.  That  is,  each  cyst  arises  separately,  so 
far  as  can  now  be  determined,  from  individual  ovisacs,  and 
remains  distinct  throughout  its  existence.  Hence  one  ovary 
may  have  two  or  three  contiguous,  nymphomaniac  cysts. 
The  cysts  frequently  involve  both  ovaries,  although  some- 
what frequently  only  one  is  affected.  However,  the  sterility 
is  as  complete  with  only  one  ovary  involved  as  when  the  dis- 
ease is  bilateral. 

There  is  wide  variation  in  the  thickness  of  the  cyst  walls. 
In  some  cases  they  burst  upon  very  slight  digital  pressure 
when  being  examined  per  rectum.  As  a  general  rule,  they 
require  moderate  pressure  before  they  are  ruptured.  In  a 
majority  of  cases,  the  cyst  wall  is  so  dense  that  it  is  unsafe 
to  rupture  it  by  rectal  pressure  and  it  requires  in  some  in- 
stances all  the  force  the  operator  can  command  to  rupture 
it  through  the  vagina.     In  rare  cases,  the  cysts  can  not  be 


Cystic  Degeneratio7i  of  the  Ovisacs 


397 


ruptured  by  manual  pressure  from  the  vagina  and  their 
contents  can  be  removed  only  by  puncture. 

The  large  nymphomaniac  cysts  necessarily  project  far  be- 
yond the  general  surface  of  the  ovary.     In  very  rare  cases, 


Fig.  12S — /,  Nyruphomaniac  cysts  ;  2,  cyslic  oviduct  aud  corpus  luteuni. 
a.  Cystic  pavilion  ;  b,  cystic  oviduct ;  c,  cornu  ;  d,  cystic  corpus  luteuni  with 
faint  girdle  of  lutein  tissue  ;  j,  e,  encapsuled  corpus  luteum  ;  /',  ostium 
abdominale  of  oviduct. 

small  nymphomaniac  cysts  are  centrally  located,  giving  to 
the  ovary  a  somewhat  spheroidal  or  merely  plump  form. 

The  symptoms  of  nymphomania  are  usually  very  pro- 
nounced and  characteristic.  The  cow  or  heifer  bellows  a 
great  deal,  more  frequently  perhaps  than  when  in  estrum. 


398  Diseases  of  the  Genital  Organs 

There  is  such  a  distinct  modification  in  the  voice  that  it  can 
scarcely  be  distinguished  from  that  of  a  bull.  The  female 
appears  to  be  in  estrum  of  an  exaggerated  type.  She  will 
mount  other  cows  whenever  opportunity  offers  and,  when 
free  with  other  cows  which  are  in  estrum,  she  will  ordinarily 
permit  them  to  mount  her.  As  a  rule  she  will  copulate  at 
any  time  with  the  bull,  but  there  are  notable  exceptions. 
Although  the  animal  shows  every  evidence  of  an  erratic 
estrum,  in  some  cases  she  will  not  copulate.  The  manifesta- 
tion of  the  erratic  sex  desire  is  not  confined  to  other  cows  or 
to  the  bull.  The  nymphomaniac  cow  may  mount  any  animal, 
or  for  that  matter  man,  if  he  is  not  on  his  guard.  In  some 
cases,  cows  kept  in  stalls  with  low  partitions  will  mount  the 
partition. 

After  the  disease  has  progressed  for  a  time,  usually  not 
more  than  a  few  weeks,  notable  changes  take  place  in  the 
pelvic  ligaments.  The  postero-superior  border  of  the  sacro- 
sciatic  ligament,  where  it  passes  from  the  tuberosity  of  the 
ischium  upward  and  forward  to  the  sacrum,  becomes  re- 
laxed, soft  and  flaccid.  The  broad  expanse  of  the  ligament 
suffers  similarly  and  sinks  into  the  pelvis,  so  that  the  gluteal 
muscles  drop  inward  toward  the  median  line  of  the  cavity, 
causing  a  deep  excavation.  The  relaxation  of  the  ligaments 
causes  marked  deformation  of  the  pelvis :  the  tuberosity  of 
the  ischium  becomes  elevated  and  the  tuberosity  of  the  ilium 
depressed.  The  sacrum  participates  in  this  change  of  posi- 
tion. Its  caudal  end  becomes  greatly  elevated  and  its  lum- 
bar end  depressed.  The  result  is  a  sharp  depression  at  the 
sacro-lumbar  articulation,  with  a  very  marked  elevation  of 
the  caudal  end  of  the  sacrum.  The  interosseous  ligaments 
between  the  ilium  and  sacrum  share  in  the  relaxation,  so 
that  the  sacro-ilial  articulation  is  relaxed.  This  results  in 
an  uncertain,  rolling  or  wobbling  gait.  If  one  stands  near 
the  animal  when  she  is  walking,  he  will  now  and  then  hear 
a  loud  grating  sound  caused  by  the  slipping  of  the  ilium 
upon  the  sacrum,  which  may  be  heard  with  considerable 
uniformity  if  the  external  tuberosities  of  the  ilium  are 
grasped  and  the  rump  of  the  cow  is  pushed  back  and  forth. 


Cystic  Degeneration  of  the  Ovisacs 


399 


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400  Diseases  of  the  (hniital  Organs 

The  unsteadiness  and  inaccuracy  of  the  gait,  combined  with 
the  frequent  mounting  of  other  cows,  ultimately  brings 
about  fractures  of  the  pelvis  in  a  large  percentage  of  cases. 
The  fracture  is  usually  through  the  shaft  of  the  ilium. 

By  studying  Fig.  128a,  it  will  be  observed  that  the  sacro- 
sciatic  ligament  (1,  1',  3)  is  apparently  designed  to  hold 
passively  in  proximity  the  sacrum,  ilium,  and  ischium.  At 
the  same  time  it  affords  the  chief  base  of  support  for  the 
long  vastus  and  gluteal  muscles.  If,  therefore,  the  ischial 
tuberosity  (Is)  moves  upward  toward  the  sacrum,  the  liga- 
ment loses  its  bone-like  rigidity  and  the  long  vastus  and 
gluteal  muscles  drop  inward,  as  shown  in  2  and  3  of  Fig. 
129.  The  relaxation  of  the  sacro-sciatic  ligament  deprives 
the  long  vastus  and  gluteal  muscles  of  their  normal  fixed 
insertion  and  adds  to  the  uncertainty  of  the  step  already 
mentioned  as  resulting  directly  from  the  relaxation  of  the 
ligaments.  The  anatomo-pathologic  mechanism  of  the  de- 
formity is  not  quite  clear.  The  direction  of  the  pelvis  in  re- 
lation to  the  spinal  axis  is  chiefly  maintained  by  the  sacro- 
iliac ligaments,  the  psoas  group  of  muscles,  and  the  pre- 
pubian  tendon  (linea  alba).  When  the  prepubian  tendon 
gives  way,  the  ischial  tuberosity  moves  upward  and  the  iliac 
tuberosity  downward,  but  the  sacrum  moves  in  harmony 
and  the  sacro-sciatic  ligament  retains  its  tone  and  tension ; 
there  is  no  sinking  in. 

The  basic  cause  of  the  ligamentous  relaxation  is  yet  more 
difficult  to  determine.  It  has  been  compared  with  the  pel- 
vic relaxation  upon  the  approach  of  parturition,  but  it  is 
utterly  different.  There  appears  to  be  some  toxic  substance 
elaborated  within  the  diseased  ovaries  which,  acting  upon 
the  central  nervous  system,  causes  these  very  remarkable 
changes. 

In  spite  of  good  feeding,  the  cow  frequently  loses  condi- 
tion rapidly;  the  hair  loses  its  lustre,  and  emaciation  is  very 
marked.  These  changes  are  well  portrayed  in  2  and  3  of 
Fig.  129. 

The  disease  occurs  but  rarely  in  heifers  and  is  observed 
chiefly  in  young  cows.     It  attacks  esi)ecially  highly  pedi- 


Cystic  DcgeneratiiDi  of  the  Ovisacs 


401 


Fig.  129 — Nymphomania. 
/,  Cow  in  health  at  close  of  official  milk  and-butter  test  ;  2,  rear  view  after 
nymphoinania  became  established  ;  j,  side  view,  do  :  4,  recovery  of  fertility 
and  health,  the  pelvic  ligaments  remaining  sunken.  26 


402  Diseases  of  the  Genital  Organs 

greed  dairy  cows  which  are  undergoing  severe  tests  for 
official  records  in  the  production  of  milk  and  butter  fat. 
Therefore  it  is  preeminently  a  disease  of  the  highest  class 
of  dairy  cows  and  has  closed  the  breeding  careers  of  many 
renowned  animals.  The  effect  of  nymphomania  upon  lacta- 
tion is  usually  very  marked  ;  the  dairying  efficiency  is  greatly 
decreased.  Generally  the  milk  flow  is  exceedingly  erratic. 
In  some  cases  a  nymphomaniac  may  yield  one  day  thirty  or 
forty  pounds  of  milk,  and  the  next  day,  five  or  ten.  One  day 
her  milk  may  contain  8  per  cent,  or  more  of  butter  fat  and 
the  next  day,  2  or  3  per  cent.  In  such  cases  there  is  abso- 
lutely no  way  by  which  a  person  may  judge  from  the  be- 
havior of  the  cow  one  day  what  it  will  be  the  next. 

Upon  examining  the  genital  tract,  the  most  marked 
change  will  be  found  in  the  ovaries.  Palpation  of  these  re- 
veals one,  two,  or  three  cysts  in  one  or  both  ovaries.  No 
recognizable  corpus  luteum  is  present.  In  very  rare  cases, 
as  stated  above,  there  may  be  a  small  central  cyst  sur- 
rounded everywhere  by  glandular  tissue.  The  unwary  prac- 
titioner may  fail  here  in  his  diagnosis.  When  the  symptoms 
of  nymphomania,  as  described  above,  are  present,  the  ex- 
aminer will  do  well  to  search  very  carefully  for  a  central 
cyst  in  case  of  the  absence  of  the  large  peripheral  type. 
The  presence  of  the  central  cyst  is  to  be  diagnosed  by  very 
careful  palpation.  The  involved  ovary,  which  is  abnor- 
mally large  for  the  size  and  breed  of  the  animal,  approaches 
the  spheroidal  shape.  If  the  ovary  is  carefully  palpated, 
one  gets  the  sensation  of  a  very  thick-walled,  tense  cyst  in 
its  center.  The  uterus  is  much  enlarged  and  extremely  flac- 
cid. It  nearly  always  contains  an  increased  amount  of  mu- 
cus or  muco-pus.  This  is  readily  revealed  by  douching. 
The  cervix  is  flaccid  and  atonic.  The  cervical  canal  is  di- 
lated so  that  it  will  ordinarily  permit  the  ready  passage  of 
one,  and  frequently  of  two  or  three  fingers.  The  vagina  and 
vulva  participate  markedly  in  the  general  atony  of  the  geni- 
tal tract.  The  vulva  is  large,  flabby,  and  readily  dilated. 
Occasionally  prolapse  of  the  cervix  through  the  vulva  re- 
sults from  the  general  atony.     In  such  cases  the  cervix  be- 


Cystic  Degeneratio7i  of  the  Ovisacs  403 

comes  badly  befouled  with  feces  and  litter  and  greatly  in- 
fected, so  that  the  mucous  membrane  is  much  swollen  and 
usually  soft. 

The  affection  generally  appears  without  warning.  Al- 
brechtsen  contends  that  it  is  one  of  the  results  of  metritis 
or  pyometra.  This  I  can  not  verify.  It  occurs  in  heifers 
which  are  not  known  to  have  been  pregnant  and  in  which 
no  history  of  metritis  is  obtainable.  Possibly  it  existed  un- 
observed, as  metritis  so  frequently  does.  I  have  also  seen 
the  disease  of  a  severe  type  within  fifteen  days  after  an  ap- 
parently normal  parturition  without  clinical  manifestations 
of  metritis.  I  believe  it  more  logical  to  reverse  this  belief 
and  attribute  the  endometritis  regularly  accompanying 
nymphomania  to  the  atony  due  to  the  ovarian  disease.  In 
severe  cases  the  sinking  of  the  pelvic  ligaments  occurs 
within  a  few  days  after  the  commencement  of  the  nympho- 
mania ;  in  the  milder  cases  the  sinking  of  the  ligaments  may 
not  be  notable  until  after  several  or  many  weeks  have 
elapsed. 

The  disease  is  extremely  chronic  and  shows  scant  ten- 
dency to  spontaneous  recovery.  Just  how  long  it  may  con- 
tinue is  quite  unknown.  I  have  seen  cases  where  the  nymph- 
omania has  existed  constantly  for  from  four  to  five  years. 
By  that  time  the  patience  of  the  breeder  generally  becomes 
exhausted  and  the  animal  is  destroyed.  Apparently  nymph- 
omania never  directly  causes  the  death  of  the  patient  but, 
indirectly,  by  destroying  the  vigor  and  tone,  may  render 
the  animal  an  easy  prey  to  intercurrent  maladies. 

Next  to  rabies,  nymphomania  in  cows  is  the  most  inter- 
esting scientifically,  and  most  important  economically 
amongst  the  diseases  of  animals  characterized  by  notable 
mental  aberration.  It  strikes  most  frequently  the  greatest 
dairy  cows,  and  all  too  often  ruins  them,  thus  causing  a 
severe  economic  loss  to  the  owner  and,  worst  of  all,  strik- 
ing down  the  very  cows  which,  by  their  potential  ability  to 
yield  great  quantities  of  milk  and  butter  and  to  grow  prog- 
eny equally  capable,  are  of  greatest  value  to  the  state. 

The  prognosis  is  unfavorable.     Numerous  writers  have 


404  Diseases  of  the  Goiital  Organs 

held  the  opposite  view  but  have  failed  to  substantiate  it 
with  extended  clinical  data.  In  my  experience,  less  than  50 
per  cent,  recover  and  many  of  these  quite  tardily.  My  cases 
have  been  chiefly  of  long  standing,  which  depresses  the 
prognosis.  In  numerous  cases,  especially  when  coming  un- 
der treatment  very  early,  the  animals  respond  immediately 
and  permanently.  In  other  cases,  if  severe  and  neglected 
for  a  year  or  more,  recovery  becomes  a  matter  of  great 
doubt.  I  have  found  no  criteria,  except  the  duration  of  the 
disease  prior  to  handling,  upon  which  to  base  the  prognosis 
in  a  given  case.  Some  of  my  worst  cases,  like  that  portrayed 
in  Fig.  129,  have  recovered  their  fertility.  Hess  and  others 
have  expressed  the  dictum  that,  when  the  cyst  is  too  dense 
for  manual  rupture  and  can  be  emptied  only  by  instru- 
mental puncture,  the  case  is  hopeless  and  the  animal  should 
be  slaughtered.  This  is  not  entirely  correct,  as  I  have  had 
several  cases  in  very  valuable  cows  which,  like  Fig.  129, 
have  recovered  fertility  after  I  had  punctured  the  cysts  once 
or  several  times.  If  a  cow  is  highly  valuable  and  there  is 
present  no  recognizable  lesion,  aside  from  the  cysts,  which 
constitutes  an  absolute  bar  to  fertility,  the  case  should  not 
be  pronounced  hopeless. 

The  handling  consists  chiefly  of  the  evacuation  of  the 
cysts  as  rapidly  as  they  form.  Many  of  them  can  be  rup- 
tured safely  and  readily  by  digital  compression  per  rectum. 
The  ovary  should  be  manipulated  carefully  per  rectum  until 
free  from  any  chance  covering  or  entanglement  within  the 
mesosalpinx  or  mesometrium,  so  that  the  cyst  comes  into 
immediate  contact  with  the  peritoneal  wall  of  the  rectum. 
The  cyst  is  then  to  be  grasped  between  the  thumb  and  two 
or  more  fingers,  and  steady  pressure  exerted  upon  it  with 
the  ball  of  the  thumb.  The  thumb  pressure  should  be  con- 
centrated upon  the  center  of  the  cyst,  and  the  hand  should 
encompass  only  as  much  of  the  cyst  wall  as  essential  to  a 
secure  grasp.  That  is,  the  greater  the  area  of  the  cyst  free 
from  compression,  and  the  more  concentrated  the  compres- 
sion upon  a  limited  area,  the  more  certainly  the  cyst  may 
be  ruptured.     1  have  found  it  advantageous  sonietinu's  (o 


Cystic  Degencratioyi  of  the  Ovisacs  405 

place  the  ovary  against  the  bony  wall  of  the  pelvis  and  then 
exert  pressure  against  the  opposite  side  with  the  hand,  thus 
impinging  the  ovary  between  the  hand  and  the  pelvic  bone. 
The  rupture  of  ovarian  cysts  per  rectum  must  always  be 
carried  out  with  prudence.  The  fingernails  should  be 
trimmed  to  the  quick  and  carefully  smoothed  in  order  to  in- 
sure the  maximum  of  safety  against  injury  to  the  rectum. 
Pressure  must  not  be  exerted  upon  the  cyst  when  the  rec- 
tum is  contracting.  If,  during  the  compression,  the  pa- 
tient begins  to  strain,  the  pressure  must  be  relaxed  and,  if 
necessary,  the  ovary  released  in  order  to  avoid  rectal  lacera- 
tion or  rupture. 

Unless  the  cyst  can  be  ruptured  safely  and  readily  per 
rectum,  the  effort  should  be  promptly  abandoned  and  the 
operation  carried  out  per  vaginam.  The  ovary  should  be 
picked  up  per  rectum  and  carried  backward  over  the  vaginal 
roof.  The  operator  then  inserts  his  other  hand  into  the 
vagina  and  grasps  the  cystic  gland  through  the  vaginal 
wall,  the  ovary  being  pushed  down  by  the  hand  in  the  rec- 
tum into  the  hand  in  the  vagina.  It  is  then  grasped  per 
vaginam,  while  the  hand  within  the  rectum  lends  security  to 
the  grasp  by  continuing  a  hold  upon  the  mesometrium  at  its 
attachment  to  the  ovary  and  maintains  a  pressure  down- 
ward, while  the  hand  in  the  vagina  presses  upward.  The 
operator  may- also  with  safety  avail  himself  of  the  assist- 
ance of  a  colleague  or  a  layman  in  his  efforts  to  rupture  the 
cysts  per  vaginam.  Any  intelligent  layman  can  be  trusted 
under  proper  supervision  to  exert  pressure  per  vaginam. 
His  nails  should  be  trimmed  as  noted  above,  and  if  his 
hands  are  horny  from  manual  labor  they  should  be  softened 
with  warm,  antiseptic  solution.  The  veterinarian  should 
locate  the  cystic  ovary  per  rectum,  obtain  a  secure  grasp 
upon  it  and  draw  it  back  over  the  vagina.  The  assistant 
should  then  insert  his  hand,  well  lubricated,  into  the  vagina, 
with  his  palm  upward.  The  veterinarian  pushes  the  ovary 
into  his  open  hand  from  above  and  maintains  his  grasp  upon 
the  ovarian  attachment.  He  then  pushes  downward  and 
steadies    the    gland    while    the    assistant    pushes    upward 


4o6  Diseases  of  the  Genital  Orga^is 

against  the  operator's  hand,  grasps  the  ovary,  and  exerts 
the  degree  of  pressure  required  to  rupture  the  cyst.  The 
vaginal  wall  will  withstand  securely  the  maximum  digital 
compression,  if  prudently  applied,  which  a  powerful  man 
can  exert. 

Sometimes  the  cyst  wall  is  so  dense  and  resistant  that, 
however  powerful  the  man  may  be,  he  can  not  rupture  the 
cyst  by  digital  compression.  If,  after  a  reasonable  effort, 
it  is  not  ruptured,  it  is  best  to  desist  and  resort  to  the  easier 
and  safer  operation  in  such  cases,  of  stabbing  the  cyst  and 
thus  evacuating  its  contents.  The  operator,  if  right-handed, 
inserts  his  right  hand  into  the  rectum,  grasps  the  cystic 
ovary,  and  draws  it  back  over  the  vagina.  The  left  hand  is 
then  inserted  into  the  vagina  and  a  secure  hold  upon  the 
ovary  obtained  by  passing  the  hand  forward  with  the  palm 
downward,  the  index  finger  passing  to  the  left  of  the  gland 


Fig.  129a — Ovarian  Scalpel 


and  the  thumb  to  the  right.  The  ovary  is  then  pressed  down 
with  the  right  hand  between  the  thumb  and  finger  of  the 
left  hand,  and  the  broad  ligament  beyond  the  ovary  securely 
grasped  so  that  the  ovary  with  the  cyst  rests  in  the  palm  of 
the  hand.  The  right  hand  is  then  withdrawn  from  the  rec- 
tum and  an  attendant  quickly  washes  off  the  feces.  The 
ovarian  scalpel  (Fig.  129a)  is  grasped  and,  guarded,  is 
pushed  carefully  along  the  forearm  and  palm  of  the  left 
hand  until  the  end  of  the  blade  is  against  the  vaginal  wall 
over  the  center  of  the  cyst.  When  sure  that  the  end  of  the 
scalpel  is  properly  placed  and  directed  toward  the  center  of 
the  cyst,  the  guard  is  released  and  the  scalpel  given  a  quick 
thrust  forward  through  the  vaginal  wall  and  the  wall  of  the 
cyst.  The  moment  the  scalpel  enters  the  cyst,  the  latter  col- 
lapses. The  scalpel  is  then  withdrawn  and  the  pressure 
continued  upon  the  cyst  until  its  contents  are  fully  evacu- 
ated.   Care  should  be  taken,  when  grasping  the  ovary  from 


Cystic  Degeneration  of  the  Ovisacs  407 

the  vagina,  that  no  viscera  and  no  part  of  the  mesometrium 
(broad  ligament  of  the  uterus)  lie  between  the  vagina  and 
the  cyst.  Since  the  cyst  is  regularly  upon  the  anterior  or 
free  border  of  the  ovary,  the  anterior  border  of  the  gland 
should  be  turned  over  upward,  backward,  and  then  down- 
ward so  that,  when  ready  for  the  stab,  the  anterior  or  con- 
vex border  of  the  ovary  shall  be  directed  downward  and 
backward,  thus  bringing  the  cyst  wall  into  direct  contact 
with  the  peritoneal  surface  of  the  vaginal  roof.  The  scalpel 
thus  passes  through  the  vaginal  roof  and  the  cyst  wall  only. 
If  the  vaginal  wall  is  tensely  stretched  over  the  ovary,  the 
stab  wound  in  it  is  reduced  to  a  minimum,  so  that,  when  the 
cyst  collapses  and  the  vaginal  wall  is  released  and  returns 
to  its  normal  state,  the  stab  wound  is  but  a  fraction  of  the 
width  of  the  scalpel  blade  in  extent.  If,  through  error,  the 
mesometrium  lies  between  the  cyst  and  the  vaginal  wall, 
the  scalpel  may  wound  it,  causing  an  extensive  hemorrhage 
in  the  broad  ligament  or  in  the  peritoneal  cavity.  If  a  com- 
petent assistant  is  available,  it  is  in  better  accord  with  sur- 
gical principles  for  the  assistant  to  grasp  the  ovary  per  rec- 
tum, carry  it  back,  and  pass  it  to  the  operator's  hand  in  the 
vagina,  so  that  the  latter  may  have  his  other  hand  unsoiled 
and  ready  to  use  the  scalpel.  Sometimes  this  would  prove 
a  material  advantage  because  the  cow  may  strain  while  the 
hand  which  has  been  used  in  the  rectum  is  being  washed, 
causing  the  operator's  hold  to  slip.  The  time  lost  may  con- 
sequently bring  about  failure  in  a  given  attempt  and  necessi- 
tate a  repetition. 

When  common  cows  become  nymphomaniac  early  in  lac- 
tation, the  veterinarian  should  consider  the  prudence  of 
handling  by  castration.  The  removal  of  the  ovaries  stops 
the  nymphomania,  stabilizes  lactation,  and  tends  to  cause 
the  animal  to  fatten  rapidly  as  the  lactation  period  nears 
its  close,  enabling  the  dairyman  to  dispose  of  the  animal 
profitably  for  beef.  When  an  animal  is  dry  or  lactation  un- 
profitable and  the  patient  has  become  extremely  emaciated, 
as  indicated  in  Fig.  129,  the  veterinarian  should  be  cautious 
about  advising  ovariotomy.    The  operation  can  not  succeed 


4o8  Diseases  of  the  Gcnilal  Organs 

economically  unless  the  owner  has  at  hand  an  abundance  of 
good  food  of  low  cost.  Thus  an  emaciated  nymphomaniac 
might  be  profitably  spayed  in  the  spring  when  an  abundance 
of  cheap  pasturage  is  available,  but  spaying  in  the  autumn 
and  attempting  to  fatten  upon  expensive  grain  might  prove 
a  serious  economic  blunder.  The  operation  of  spaying  has 
already  been  described  in  Chapter  XL 

When  recovery  occurs,  the  nymphomania  abates,  the  gen- 
eral condition  improves,  the  hair  recovers  its  lustre,  and  the 
deformation  of  the  pelvis  becomes  lessened  or  disappears. 
In  mild  or  recent  cases,  recovery  of  fertility  is  signalized 
by  the  return  of  the  pelvis  to  its  normal  form.  Long-stand- 
ing, severe  cases  do  not  recover  wholly  from  the  pelvic  de- 
formity, but  do  improve  in  form  with  the  restoration  of  fer- 
tility. This  is  well  shown  in  Fig.  129,  where  the  cow  is 
shown  in  health  in  1,  the  disease  at  its  maximum  in  2  and  3, 
and  the  partly  recovered  form  of  the  pelvis  in  4.  The  im- 
pression given  by  the  figure  in  4  may  be  somewhat  exag- 
gerated because  she  had  just  calved,  at  which  period  there 
is  regularly  some  relaxation  of  the  pelvic  ligaments,  but  the 
photograph  is  essentially  true  to  clinical  observation. 

A  nymphomaniac  should  on  no  account  be  permitted  to 
copulate,  since  this  definitely  intensifies  the  malady. 
Neither  should  she  be  permitted  to  consort  with  other 
cattle  because,  in  repeatedly  mounting  or  attempting  to 
mount  them,  she  is  very  liable  to  injure  herself  (fractures 
of  pelvis,  etc.)  or  other  animals.  She  is  a  great  annoyance 
in  a  herd  of  dairy  cows,  constantly  disturbing  them,  inter- 
fering with  their  feeding,  and  hence  with  the  milk  yield. 

When  the  cow  improves  and  apparently  recovers,  care 
should  be  taken  in  permitting  copulation.  When  the 
nymphomania  ceases  and  the  general  condition  improves, 
she  should  not  be  bred  during  the  first  appearance  of  es- 
trum,  as  this  may  be  false  and  a  mere  recrudescence  of  the 
nymphomania.  Even  if  it  is  due  to  the  ripening  of  an  ovi- 
sac, copulation  should  not  be  permitted.  The  breeder 
should  wait  until  the  advent  of  a  second  normal  estrum. 
The  two  periods  have  a  normal  interval  of  20  to  22  days. 


Intra- Follicular  Hemorrhage  409 

So  long  as  the  estrual  period  is  irregular,  she  should  not  be 
bred.  Until  the  recovery  is  complete,  copulation  generally 
precipitates  the  return  of  the  nymphomania  in  a  severe 
form,  with  a  copious  discharge  of  muco-pus  from  the  vulva. 
If  regular  and  normal  in  estrum  and  in  the  length  of  the 
inter-estrual  period,  the  cow  may  be  bred  at  the  second 
estrum  and  then  watched  closely  to  see  that  all  is  going  well. 
The  treatment  of  nymphomania  through  the  internal  ad- 
ministration of  therapeutic  agents  has  not  been  given  suffi- 
cient study  to  afford  ground  for  the  expression  of  any 
opinion.  Upon  the  hypothesis  that  the  disease  is  due  to  in- 
fection within  the  ovary,  it  would  seem  not  improbable 
that  the  internal  administration  of  powerful  disinfecting 
agents  might  bring  about  relief  from  the  disease.  I  have 
used  salvarsan  to  a  very  limited  extent.  Apparently  it 
brought  about  some  amelioration  of  the  disease,  but  the 
experiments  were  brought  to  a  close  on  account  of  the  pro- 
hibitive expense  of  the  drug.  In  a  very  few  cases  the  in- 
travenous administration  of  trypan  blue  seemed  to  benefit 
the  animals  greatly;  in  other  instances  no  apparent  benefit 
was  derived  from  it.  Quite  as  interesting  from  the  stand- 
point of  research  with  nymphomania,  is  the  use  of  corpus 
luteum  or  ovarian  extract,  but  so  far  as  I  know,  this  field 
of  experimentation  has  not  been  extensively  invaded.  I 
have  used  liberal  amounts  of  corpus  luteum  extract  upon 
two  nymphomaniacs,  without  visible  effect.  It  is  possible 
that  extracts  of  other  ductless  glands  might  affect  this  dis- 
ease profoundly. 

3.      INTRA-FOLLICULAR   HEMORRHAGE 

I  have  in  my  collection  the  genital  tract  from  an  abattoir 
heifer,  illustrated  in  Fig.  130,  in  which  the  right  ovary  con- 
tains a  number  of  large  cysts  which  have  increased  its  di- 
ameter to  four  inches  and  its  weight  to  about  two  pounds. 
Some  of  the  cysts  contain  a  clear  lymph.  Others  contain 
blood  and  lymph  mixed  in  varying  proportions,  some  of 
them  being  filled  almost  entirely  with  blood.  No  lutein 
tissue  is  recognizable.    I  have  not  recognized  the  condition 


4IO 


Diseases  of  the  Genital  Organs 


clinically.  As  I  have  no  clinical  history  of  the  animal,  the 
significance  of  the  condition  is  uncertain.  The  genital  or- 
gans are  those  of  a  heifer  which  has  not  been  pregnant. 
The  specimen  suggests,  as  do  many  ovarian  diseases,  cau- 
tion upon  the  part  of  the  veterinarian.  In  the  handling  of 
cows  for  sterility,  as  in  most  new  fields,  arbitary  practices 
have  developed.  One  of  the  outstandingly  dangerous  fads 
in  sterility  of  cattle  is  the  massaging  of  the  ovaries  and 
uterus  per  rectum,  the  rupturing  of  cysts,  and  the  dislodg- 
ment  of  corpora  lutea — a  massaging  and  crushing  program. 
Although  the  healthy  genital  organs  of  cows  will  endure 


Fig.  i-^o— Intra-FoUicular  Hemorrhag-e.     Aballoir  laifer. 
/,  Right  ovary  ;  2.  2,  uterine  coriiua  ;    ,,\  gelalinized  cystic  fluid  ;   /,  hem- 
orrhage into  cystic  fluid. 

without  great  injury  a  remarkable  amount  of  insult,  their 
limit  of  endurance  is  promptly  exceeded  in  many  cases  of 
disease.  Any  cyst  of  extraordinary  volume  or  presenting 
other  unusual  features,  or  any  other  lesion,  the  nature  of 
which  is  not  clear,  calls  for  careful  consideration  and  for- 
bids hasty  action.  A  rupture  of  the  cysts  illustrated  would 
in  all  probability  have  led  to  fatal  hemorrhage.  Fig.  67 
illustrates  further  this  important  point.  In  this  animal, 
where  clinical  history  was  available,  spontaneous  rupture 
of  the  ovary  occurred,  with  profuse  hemorrhage.  Had  an 
imprudent  veterinarian  "ruptured  the  cyst"  in  that  case, 


Post- Ovulation  Hemorrhaqe  info  the  Follicular  Crater     411 

death  from  hemorrhage  would  have  been  almost  certain 
and  the  over-rash  operator  would  have  received  severe  and 
well  merited  censure.  Unusual  cysts  or  other  enlargements 
or  lesions  should  always  be  handled  with  extreme  caution, 
and  no  irretraceable  step  made  until  a  reliable  diagnosis 
has  been  reached.  It  is  well  in  doubtful  cases  of  cysts  or 
tumors  always  to  palpate  the  ovarian  artery  carefully.  It 
may  be  enlarged,  which  clearly  forbids  any  form  of  pro- 
cedure inviting  hemorrhage  unless  the  operation  provides 
for  absolute  control  of  it. 

4.    post-ovulation  hemorrhage  into  the  follicular 
Crater 

Immediately  after  ovulation  there  is  physiologically  a 
slight  hemorrhage  into  the  crater  of  the  ruptured  ovisac, 
to  form  a  very  small  hematoma  which  occupies  for  a  brief 
time  the  center  of  the  corpus  luteum  and  then  disappears, 
as  indicated  in  Fig.  26. 

Pathologically  there  occurs  not  infrequently  an  amount 
of  hemorrhage  into  the  ovulations  crater  far  in  excess  of 
the  physiologic  volume.  Clinically  I  have  encountered  ex- 
tensive blood  clots  marking  the  site  of  the  crater,  which  are 
readily  detached  so  that  they  drop  freely  into  the  peritoneal 
cavity.  In  one  instance  the  hematoma  was  more  than  3 
inches  in  diameter.  Presumably  considerable  blood  had 
escaped  into  the  peritoneal  cavity  in  addition  to  that  which 
remained  attached  to  the  ovary  as  a  hematoma.  The  cause 
is  not  definitely  known.  Apparently  it  is  due  to  a  disturb- 
ance of  the  circulation  dependent  upon  general  atony  of  the 
ovary.  Just  how  serious  it  may  prove  at  times  is  unknown. 
Now  and  then  a  cow  appears  quite  unwell  at  the  close  of  her 
estrual  period.  It  is  not  improbable  that  hemorrhage  from 
the  follicular  crater  may  at  times  be  responsible  for  the 
symptoms.  It  is  a  well-known  fact  that  in  rare  cases 
severe  and  even  fatal  hemorrhage  follows  the  dislodgment 
of  a  corpus  luteum.  The  two  occurrences  may  be  similar 
in  their  fundamental  character.  The  clot,  which  is  fairly 
firm,  breaks  up  under  digital  compression  with  a  charac- 
teristic grating. 


412 


Diseases  of  the  denital  Organs 


When  the  hematoma  is  discovered  during  the  examination 
of  the  genital  organs,  it  is  doubtful  just  what  course  is  best 
to  pursue.  I  have  followed  the  plan  of  dislodging  it  and 
turning  it  free  into  the  peritoneal  cavity,  but  have  always 
taken  the  precaution  of  applying  digital  compression  to  the 
ovary  for  some  minutes  after  the  dislodgment  of  the  hema- 
toma, and  watching  very  closely  to  see  that  the  hemorrhage 
did  not  recur.  This  appears  to  me  to  be  the  better  course 
because,  unless  the  hematoma  is  dislodged,  so  far  as  I  am 
able  to  determine,  it  will  result  in  a  hemorrhagic  corpus 
luteum,  which  will  undergo  cystic  degeneration  and  will 
inhibit  estrum  for  a  long  period  of  time. 

The  cause  of  this  excessive  hemorrhage  is  undetermined, 
but  it  is  apparently  due  to  the  presence  of  an  infection  in 
the  ovary  which  has  depressed  the  tonicity  of  the  blood  ves- 
sels, causing  them  to  bleed  freely  upon  the  slightest  inter- 
ference.    So  far  as  I  have  observed,  the  prognosis  is  good. 

5.    Hemorrhagic  Corpus  Luteum 

The  excessive  hemorrhage  into  the  crater  of  the  ruptured 
ovisac,  described  in  the  preceding  paragraph,  when  left  un- 
disturbed, regularly  leads  to  a  hemorrhagic  corpus  luteum, 
so  far  as  I  am  able  to  determine.  Eventually,  also,  the 
hemorrhagic  corpus  luteum  generally,  if  not  always,  results 
in  cystic  degeneration.  The  lutein  tissue  itself,  under  these 
conditions,  ordinarily  acquires  its  normal  volume,  or  may 
exceed  it  somewhat.  Accordingly  the  blood  clot  adds  to  the 
volume  of  the  corpus  luteum,  so  that  in  numerous  instances 
it  reaches,  as  palpated  per  rectum,  a  diameter  of  one  to  two 
or  more  inches  (Hypertrophied  Corpus  Luteum).  Between 
the  physiologic  blood  clot  in  the  corpus  luteum  and  the  maxi- 
mum amount  of  blood  described,  there  is  every  possible 
gradation  in  amount. 

Clinically  it  is  impossible  to  diagnose  directly  the  hemor- 
rhagic corpus  luteum.  A  tentative  diagnosis  may  be  made, 
based  upon  the  increased  size  of  the  corpus  luteum.  The 
hemorrhagic  corpus  luteum  tends  to  persist  for  an  indefinite 
period,  inhibiting  estrum  until  it  finally  disappears  by  cystic 


Honorrhagic  Corpus  Luteum  413 

degeneration.  Its  precise  nature  has  not  been  made  clear. 
The  cystic  corpus  luteum  is  so  generally  associated  with  in- 
fection as  to  suggest  that  the  hemorrhage  causing  this  path- 
ologic type  of  corpus  luteum  may  be  due  to  atony  in  the 
gland,  referable  to  infection.  At  present  it  seems  that  as  a 
rule  of  practice  it  is  best  to  dislodge  such  corpora  lutea  in 
order  that  their  inhibitory  power  may  be  destroyed  and  the 
ovaries  caused  to  resume  their  function.  The  veterinarian 
should  always  be  very  careful,  when  dislodging  such  a  cor- 
pus luteum,  to  compress  the  crater  for  some  minutes  and 
watch  carefully  for  a  brief  period  afterward  to  see  that  a 
new  hemorrhage  is  not  established.  At  the  same  time  due 
attention  should  be  given  to  other  conditions  existing  within 


1^% 


Fig.  T31 — Hemorrhagic  Corpus  Luteum. 

the  genital  tract,  because  there  is  ordinarily  a  correlation 
of  these  diseases  and  no  one  lesion  should  be  treated  as  be- 
ing wholly  independent  of  other  pathologic  conditions  which 
may  be  present. 

6.    Cystic  Degeneration  of  the  Corpus  Luteum 

Probably  the  commonest  disease  of  the  ovary  observed  in 
cattle  is  the  cystic  degeneration  of  the  corpus  luteum.  At 
the  same  time,  although  the  condition  has  not  been  thor- 
oughly studied,  it  is  quite  safe  to  say  that  it  is  one  of  the 
most  serious  types  of  ovarian  infection  seen.  Cystic  de- 
generation of  the  corpus  luteum  occurs  very  rarely  in  a 


414 


Diseases  of  the  Genital  Organs 


pregnant  cow,  and  when  it  does  occur  the  cyst  is  usually 
very  small.  It  is  a  very  common  condition  in  sterile  cows 
and  is  almost  universal  in  complete  adhesion  of  the  ovary 
within  the  pavilion  of  the  oviduct  or  within  the  ovarian 
pocket  in  the  broad  ligament. 

In  the  abattoir  one  encounters  every  possible  degree  of 
cystic  degeneration  of  the  corpus  luteum.  At  first  there  is 
frequently  a  small  cyst  not  much  larger  than  an  ordinary 
pinhead.  On  the  other  hand,  there  occur  cystic  corpora 
lutea  in  which  the  cysts  are  two  to  three  inches  or  more  in 
diameter.  Frequently  the  cystic  degeneration  destroys  the 
lutein  tissue  until  there  is  merely  a  yellow  band  about  the- 
periphery  of  the  cyst.  Sometimes  the  lutein  tissue  disap- 
pears from  all  of  the  wall  except  a  very  small  area.  In  other 
cases,  where  the  corpus  luteum  has  been  hemorrhagic,  there 
will  be  seen  at  the  periphery  of  the  cyst  at  one  point  a  trace 
of  lutein  tissue  and  at  another  a  trace  of  the  old  hematoma. 
Finally  all  traces  of  lutein  tissue  or  hemorrhage  disappear 
and  there  is  left  behind  a  cyst  that  cannot  be  differentiated 
structurally  from  that  of  nymphomania,  though  it  does  not 
cause  that  disease. 

When  examining  a  sterile  cow  clinically,  one  may  recog- 
nize the  cystic  character  if  the  cyst  occupies  one-third  to 
one-half  the  volume  of  the  corpus  luteum.  If  pressure  is 
applied  to  the  corpus  luteum,  the  cyst  ruptures  and  the 
fluid  escapes,  after  which,  if  the  digital  compression  is  con- 
tinued, the  lutein  mass  itself  is  pressed  out  and  the  cavity 
feels  like  an  empty  bag.  When  the  cystic  degeneration  has 
extended  to  an  extreme  degree,  the  examiner  merely  recog- 
nizes the  cyst.  It  should  be  distinguished  clinically  from 
the  nymphomaniac  cyst,  because  of  the  nymphomania  itself. 
It  is  further  distinguishable  in  many  cases  by  the  fact  that, 
after  rupturing  the  cyst  and  then  applying  digital  compres- 
sion to  the  crater,  a  small  amount  of  hard  tissue  is  detached 
and  forced  out  which  is  recognizable  as  the  peripheral  por- 
tion of  the  corpus  luteum.  How  large  these  cysts  may  grow 
is  wholly  unknown.  In  discussing  benign  tumors  in  Chap- 
ter XI,  there  have  been  included  a  number  of  largo  ovarian 


Cysiic  Degeneration  of  the  Corpus  Luteiim  415 

cysts  which  have  their  principal  danger  for  the  animal  in 
their  mechanical  interference  with  other  viscera.  Their 
origin  is  unknown.  It  is  not  improbable  that  a  considerable 
proportion  of  them  have  their  origin  in  the  cystic  degenera- 
tion of  the  corpus  luteum. 

The  origin  of  the  cystic  corpus  luteum  has  not  been  ex- 
tensively studied.  Judging  from  clinical  and  post-mortem 
studies,  it  appears  quite  justifiable  to  say  that  the  disease 
is  referable  to  an  infection  which  enters  the  crater  of  the 
freshly  ruptured  ovisac  from  the  oviduct.  Hence  the  cystic 
corpus  luteum  is  seen  with  great  frequency  in  instances  of 


^  33  ^  ^ 


'<«s^#t%l^ 


to  11 


Fio.  132 — Cystic  Corpora  Lutea. 

/,  2,  Twin  corpora  lutea  of  pregnancy  ;  j,  3a, 

4,  5,  cystic  corpora  lutea. 

chronic  salpingitis.  In  fact  a  large  percentage  of  cows  and 
heifers  persistently  sterile  because  of  salpingitis  suffer  sim- 
ultaneously from  cystic  degeneration  of  the  corpus  luteum. 
When  the  ovary  becomes  adherent  within  the  pavilion  of  the 
tube,  cystic  degeneration  of  the  corpus  luteum  is  essentially 
constant. 

The  bacteriology  of  the  cystic  degeneration  of  the  corpus 
luteum  has  been  but  scantily  studied.  Thus  far  the  studies 
have  revealed  chiefly  the  presence  of  a  streptococcus  of  the 
viridans  group. 

In  many  sterile  animals,  the  cystic  degeneration  of  the 
corpus  luteum  advances  somewhat  rapidly,  causing  no  ma- 
terial enlargement  of  the  corpus  luteum  but  gradually  de- 
stroying the  lutein  tissue,  until  finally  it  no  longer  inhibits 


Diseases  of  the  Genital  Organs 


Cystic  Degeneration  of  tlie  Corpus  Luteiim  417 

ovulation.  Sometimes  ovulation  and  estrum  are  regular 
and  the  duration  of  the  disease  is  approximately  the  same 
as  in  the  normal  cycle  of  estrum.  In  many  cases,  however, 
cystic  degeneration  interrupts  the  normal  estrual  cycle  so 
that,  if  the  degeneration  is  very  rapid,  the  animal  may  be  in 
estrum  again  in  eight  to  fifteen  days,  or  it  may  be  delayed 
until  thirty  days  or  more.  So  far  as  I  have  been  able  to 
judge  by  clinical  study,  it  is  the  principal  cause  of  irregu- 
larity in  the  estrual  cycle.  Not  only  does  it  interrupt  the 
estrual  cycle  in  the  non-pregnant  animal,  but  sometimes  it 
involves  the  pregnant  animal,  bringing  about  a  recurrence 
of  estrum  in  spite  of  the  presence  of  a  normally  developing 
fetus. 

The  prognosis  of  cystic  degeneration  of  the  corpus  luteum 
is  unfavorable  because,  so  far  as  at  present  understood,  it 
is  largely  dependent  upon  an  irremediable  infection  in  the 
oviduct.  If  it  involves  only  one  ovary  and  oviduct,  the  prog- 
nosis may  be  good  because  of  the  freedom  of  the  other  side, 
but  unfortunately  cystic  degeneration  of  the  corpus  luteum 
and  tubal  infection  are  usually  bilateral.  Some  cases  re- 
cover, but  when  it  is  once  clearly  recognizable  one  needs  to 
give  a  very  guarded  or  unfavorable  prognosis. 

There  is  no  well-established  method  for  handling  cystic 
degeneration  of  the  corpus  luteum  which  promises  favorable 
results.  It  has  been  the  habit  with  many,  especially  in  the 
beginning  of  the  work  with  sterility  in  cattle,  to  dislodge  the 
cystic  corpus  luteum,  but  when  one  views  the  question  from 
the  standpoint  of  the  etiology  as  interpreted  above,  it  would 
appear  that  tampering  with  such  a  condition  is  not  usually 
justifiable.  If  one  dislodges  the  corpus  luteum,  there  is  a 
new  wound  which  offers  an  excellent  avenue  for  invasion 
from  the  oviduct.  It  may  be  thoroughly  justifiable  to  dis- 
lodge the  corpus  luteum,  or  at  least  to  compress  it  sufficiently 
to  rupture  the  cyst  in  its  center  in  order  to  make  a  diagnosis. 
When  the  diagnosis  has  been  made,  however,  and  the  veteri- 
narian is  aware  that  the  difficulty  is  due  to  this  cystic  de- 
generation and  understands  that  it  is  almost  certainly  ac- 
companied by  salpingitis,  the  more  prudent  course  in  the 
27 


41 8  Diseases  of  the  Genital  Orga7is 

present  state  of  our  knowledge  is  to  let  the  body  alone,  un- 
less it  is  greatly  prolonging  the  estrual  period,  and  to  hope 
that  there  may  be  a  spontaneous  control  of  the  condition, 
possibly  assisted  by  giving  careful  attention  to  the  cervix 
and  uterus  if  they  are  participating  in  the  general  infection 
present. 

7.    Hypertrophy  of  the  Corpus  Luteum 

Much  has  appeared  in  the  writings  of  some  veterinarians 
regarding  hypertrophy  of  the  corpus  luteum  in  cattle.  They 
have  not  as  a  rule  defined  precisely  what  is  meant  by  the 
term.  In  examining  thousands  of  cattle  in  the  abattoir.  I 
have  observed  but  one  true  case  of  hypertrophy  of  the  cor- 
pus luteum.  and  in  that  case  the  body  was  black  instead  of 
yellow  and  the  cow  was  pregnant.  This  enlarged  corpus 
luteum  is  shown  in  Fig,  131. 

There  is  another  type  of  corpus  luteum.  however,  which 
has  been  described  in  the  two  preceding  paragraphs  as 
hemorrhagic  corpus  luteum  and  cystic  degeneration  of  the 
corpus  luteum.  in  which  the  gross  volume  of  the  body  may 
attain  an  indefinite  size.  I  have  not  been  able  to  observe 
that  the  actual  volume  of  true  lutein  tissue  has  been  ma- 
terially increased.  It  is  impossible,  however,  to  differen- 
tiate clinically  between  a  true  increase  of  lutein  tissue  and 
an  increase  in  the  size  of  the  corpus  luteum  because  of  the 
presence  of  an  old.  hard  blood  clot  of  such  consistence  that 
it  cannot  be  distinguished  from  lutein  tissue.  It  is  well 
then  to  retain  the  designation  "hypertrophy  of  the  corpus 
luteum,"  as  a  clinical  phenomenon,  whether  it  is  due  to  the 
addition  of  a  blood  clot  in  the  lutein  tissue  or  to  cystic  de- 
generation in  the  center.  When  such  a  corpus  luteum  is 
present,  it  is  almost  invariably  associated  with  sterility  and 
inhibits  estrum  for  an  indefinite  period.  Upon  clinical  ex- 
amination the  operator  recognizes  in  one  of  the  ovaries  an 
abnormally  large  corpus  luteum.  In  many  of  these  cases, 
if  he  will  palpate  very  carefully,  cystic  degeneration  may  be 
recognized,  although  not  yet  far  advanced.  Such  corpora 
lutea  attain  a  diameter  of  one  to  two  and  one-half  inches  or 


Hypertrophy  of  the  Corpus  Licteiim 


419 


even  somewhat  greater.  When  the  corpus  luteum  contains 
a  blood  clot,  it  always,  so  far  as  I  have  seen,  ultimately  un- 
dergoes cystic  degeneration,  but  the  degeneration  may  be 
very  slow  and  the  presence  of  the  corpus  luteum  may  inhibit 
estrum  month  after  month. 


Fig.  134 — Cystic  Corpus  Luteum. 

/,  /,  Pair  of  ovaries,  the  one   on   the  left  having  a   very  large  cystic  corpus 

luteuin,  showing  at  the  lower  right  periphery  a  remnant  of 

lutein  tissue,  A^;  P,  P,  paired  ovaries  of  pregnancy. 

The  prognosis  is  good.  As  a  general  rule,  once  the  en- 
larged corpus  luteum  is  dislodged,  estrum  returns  within 
three  to  five  days  and  there  is  fair  opportunity  for  concep- 
tion. It  appears  that  the  long  rest  of  the  genital  tract, 
caused  by  the  inhibition  of  estrum  by  the  enlarged  body, 
tends  to  bring  about  a  healthy  condition  of  the  genital  sys- 
tem, so  that  when  the  inhibiting  body  is  dislodged  the  ova- 


420  Diseases  of  the  Genital  Organs 

ries  function  normally.  In  one  heifer  which  had  aborted  at 
six  months  and  five  or  six  months  later  had  not  been  seen  in 
estrum,  I  dislodged  a  corpus  luteum  fully  two  inches  in  di- 
ameter, which  immediately  reformed  in  the  old  crater.  I 
dislodged  it  a  second  time,  about  fifteen  days  later,  after 
which  the  animal  came  in  estrum  and  conceived  at  the  first 
service. 


Jh'io    135— Adherent  Ovary  with  Very  Large  Cystic  Corpus  Luteum. 

/,   Apex  of  cormi  ;    _->,  K'--l;>li>ii''-'-'«l  <^v.sl  Huid  ;    j\  Uiiii  la\cr  of  luleni  tissue  ; 

/,  heniatoina    displaciiij^    liilein  tissue.       Lutein  tissue  and 

old  blood  clot  alternate  about  periphery  of  cvsl 

The  dislodgment  of  the  hypertrophied  corpus  luteum 
should  preferably  be  accomplished  by  compression  from  the 
vagina.  Frequently  it  is  so  difficult  to  dislodge  that,  if  the 
operation  is  attempted  per  rectum,  there  is  danger  of  in- 
jury. Moreover,  there  is  always  danger  that  hemorrhage 
may  follow  or  that  the  dislodgment  may  be  incomplete.  It 
is  then  best  to  pass  one  hand  into  the  rectum,  bring  the  ovary 
back  over  the  vagina,  grasi)  it  with  the  other  hand  through 


Persistent  Corpus  Liiteum 


421 


the  roof  of  the  vagina,  and  dislodge  the  corpus  luteum  care- 
fully and  completely.  When  this  has  been  done,  the  com- 
pression should  be  continued  upon  the  ovary  for  some  min- 
utes, in  order  to  anticipate  any  possibility  of  serious  hemor- 
rhage. Ordinarily  estrum  occurs  within  three  to  five  days, 
when,  if  other  conditions  are  favorable,  breeding  may  occur. 

8.    Persistent  Corpus  Luteum 

Writers  upon  the  subject  of  sterility  describe  very  fre- 
quently a  persistent  corpus  luteum.     In  the  preceding  sec- 


FiG.  136 — Cystic  Degeneration  of  Corpus  Luteum. 

Left  figure,  CL,  corpus  luteum  of  pregnancy  for  comparison  ;  ri.i^ht  figure 

with  2  cysts,  C,  C,  the  left  cyst  having  remnant  of  lutein  tissue  at  CL. 

tion,  it  has  been  mentioned  that,  when  the  corpus  luteum  is 
hemorrhagic  or  when  it  undergoes  cystic  degeneration,  its 
destruction  and  absorption  may  be  indefinitely  delayed.  In 
the  following  paragraph  (9)  the  question  of  the  central  or 
imbedded  corpus  luteum  will  be  discussed.  There  is,  how- 
ever, a  third  group  of  corpora  lutea  which,  although  appar- 
ently sound  and  normal  in  volume,  tend  to  remain  indefi- 
nitely without  undergoing  either  atrophy  or  degeneration. 
The  only  symptom  of  such  condition  is  that  the  animal  has 
not  been  bred  or  has  not  conceived  and  does  not  come  in 
estrum.    Upon  examination,  the  genital  tract  in  general  may 


422  Diseases  of  the  Genital  Orgayis 

be  normal,  the  health  of  the  patient  is  apparently  perfect, 
and  there  is  present  in  one  of  the  ovaries  a  typical  corpus 
luteum  of  ordinary  size,  form,  and  consistency.  Under 
these  conditions,  persistent  corpus  luteum  is  diagnosed.  The 
diagnosis  may  be  subject  to  question.  It  is  quite  possible 
that  in  many  cases  estrum  has  been  overlooked.  Since  some 
cattle  are  not  demonstrative  and  some  attendants  are  not 
very  alert  in  recognizing  estrum,  it  is  not  improbable  that 
many  cases  diagnosed  as  persistent  corpus  luteum  are  really 
instances  of  failure  upon  the  part  of  the  attendant  to  ob- 
serve estrum.  Hov^^ever  frequent  error  may  be,  the  condi- 
tion does  occur  and  should  be  promptly  recognized  by  the 
veterinarian.  I  have  observed  cows  where  every  opportu- 
nity was  given  for  them  to  exhibit  symptoms  of  estrum  and 
where  they  had  shown  no  such  signs  over  a  period  of  six 
months  or  more.  Upon  examination,  the  entire  genital  sys- 
tem is  found  to  be  normal,  including  an  apparently  normal 
corpus  luteum  in  one  of  the  ovaries.  The  general  health  of 
the  animal  is  beyond  criticism,  and  no  apparent  reason  ex- 
ists for  failure  of  ovulation  and  estrum.  Under  these  condi- 
tions the  dislodgment  of  the  corpus  luteum  causes  the 
prompt  appearance  of  estrum,  and  as  a  general  rule  the  ani- 
mal conceives  readily.  The  long  inhibition  of  estrum  has 
apparently  served  as  a  definite  and  valuable  period  of  rest, 
so  that,  when  the  barrier  is  overcome  and  the  genital  or- 
gans function,  conception  is  prompt, 

9.     The  Central  or  Embedded  Corpus  Luteum.     The 
Corpus  Luteum  of  Pyometra  and  Fetal  Retention 

When  an  ovisac  approaches  maturity,  it  pushes  its  way,  in 
the  cow,  toward  the  convex,  free  surface  of  the  ovary,  to 
protrude  eventually  beyond  the  general  ovarian  surface. 
It  then  ruptures  and  the  corpus  luteum  which  forms  in  its 
crater,  when  grown,  also  projects  above  the  ovarian  level. 
Such  projection  persists  throughout  the  physiologic  career 
of  the  body,  until  it  atrophies  preparatory  to  a  new  ovula- 
tion, when  it  may  (or  may  not)  sink  more  deeply  into  the 
gland  as  it  gradually  disappears. 


The  Central  or  Embedded  Corpus  Luteum  423 

Pathologically,  when  there  is  extensive  pyometra  follow- 
ing closely  upon  parturition,  or  retention  of  a  fetus  with 
putrid  maceration  or  desiccation,  the  corpus  luteum,  with- 
out undergoing  either  material  reduction  in  size  or  cystic 
degeneration,  commonly  sinks  deeply  into  the  ovarian  tissue 
and  comes  to  rest  in  a  comparatively  central  position,  to  re- 
main unchanged  for  an  indefinite  period  of  time.  Ordina- 
rily its  presence  does  not  directly  call  for  clinical  diagnosis, 
because  it  is  a  mere  adjunct  to  a  grosser,  more  striking  con- 
dition. The  presence  of  an  embedded  corpus  luteum  may, 
therefore,  be  diagnosed  usually  with  fair  safety  by  the  pres- 
ence of  the  retained  fetus  or  the  pyometra.  If  the  ovary  is 
palpated,  the  corpus  luteum  may  not  be  very  evident  to  the 
inexperienced  practioner.  The  ovary  is  spheroidal  and  un- 
naturally plump,  but  the  corpus  luteum  is  so  deeply  em- 
bedded that  it  is  not  clearly  palpable.  Careful  and  deliber- 
ate palpation  finally  enables  the  examiner  to  detect  a  firm 
central  body  or  "core"  in  the  gland  which,  in  conjunction 
with  the  retained  fetus  or  pyometra,  leads  to  a  positive  diag- 
nosis. In  one  or  two  instances  I  have  encountered  clini- 
cally an  embedded  corpus  luteum  without  retained  fetus  or 
pyometra.  It  then  had  the  significance  of  the  ordinary  re- 
tained corpus  luteum ;  it  inhibited  estrum  over  an  indefinite 
period.  Professor  Hess  was  first  to  draw  definite  attention 
to  the  inhibitory  pawer  of  retained  and  embedded  corpora 
lutea.  They  not  only  inhibit  estrum  but  at  the  same  time 
inhibit  the  spontaneous  expulsion  of  the  fetal  cadaver  or 
the  pus  contained  in  the  uterus. 

The  embedded  corpus  luteum,  like  the  retained  yellow 
body,  should  be  located  and,  in  order  to  accelerate  uterine 
contraction,  should  be  dislodged.  The  removal  of  the  cor- 
pus luteum,  the  best  method  known  for  causing  the  expul- 
sion of  a  desiccating  fetal  cadaver,  adds  materially  to  the 
efficacy  of  other  agencies  in  the  handling  of  pyometra. 
Often  the  removal  of  the  corpus  luteum  is  far  from  easy. 
The  coordinate  disease  of  the  uterus,  with  the  increased 
weight  and  volume,  drags  the  ovary  downward  and  for- 
ward into  the  abdomen,  where  it  is  difficult  to  reach.    Since 


424  Diseases  of  the  Genital  Orga?is 

it  is  ordinarily  held  too  far  forward  to  permit  it  to  be  car- 
ried back  above  the  vagina,  dislodgment  must  be  attempted 
by  compression  per  rectum.  The  ovarian  tissue  more  or 
less  completely  surrounds  it  with  firm  tissue  which  can  be 
ruptured  only  with  great  force. 

Whenever  possible,  the  dislodgment  of  the  corpus  luteum 
should  be  made  per  vaginam.  In  pyometra  the  uterine  con- 
tents should  first  be  siphoned  out,  when  ordinarily  the  ovary, 
containing  the  yellow  body,  may  be  brought  back  over  the 
vagina  and  the  dislodgment  undertaken  from  there  with 
safety.  The  mechanism  of  dislodgment  is  essentially  that 
of  rupturing  cysts.  The  compression  should  be  concentrated 
upon  the  base  of  the  ovary  by  its  ligament,  leaving  the  con- 
vex border  free  to  break  and  permit  the  escape  of  the  yel- 
low body.  Care  should  be  taken  to  get  all  of  the  lutein  tis- 
sue, that  the  body  may  not  reform  without  ovulation.  In 
■one  instance,  where  fortunately  the  ovary  could  be  brought 
back  over  the  vagina,  I  could  not  dislodge  the  yellow  body 
by  compression  and  was  forced  in  the  end  to  stab  the  ovary, 
as  described  in  connection  with  the  cysts  of  nymphomania. 
When  the  ovarian  capsule  and  overlying  ovarian  tissue  are 
incised,  although  the  stab  is  very  narrow,  the  incision 
weakens  the  structure,  the  cut  extends  under  compression, 
and  the  yellow  body  is  forced  out. 

Although  I  have  not  met  such  cases,  it  probably  occurs 
in  some  instances  that  the  operation  cannot  be  carried  out 
per  rectum  or  per  vaginam.  Then,  especially  in  desiccated 
fetus,  laparotomy  is  indicated  when  the  ovary  can  be  acted 
upon  directly. 

10.    Abscess  of  Ovary 

I  have  not  observed  primary  ovarian  abscess.  In  connection  with 
tubal  infections,  tubo-ovarian  abscesses  are  not  rare.  Where  trace- 
able, they  originate  secondarily  from  pyosalpinx  subsequent  to  mar- 
ginal adhesion  of  the  pavilion  of  the  tube  to  the  gland.  The  lesion 
is  consequently  one  of  pyosalpinx,  in  which  the  pus  first  surrounds 
the  ovary  and  then  destroys  it.  This  will  be  considered  later  under 
tubal  infections. 


Parovarian  Cysts  425 

11.    Corpora  Nigra 

I  have  seen  two  instances  of  black  instead  of  yellow  bodies  in  the 
ovaries  of  pregnant  cows.  One  was  of  normal  size,  form,  and  con- 
sistency; the  other  was  greatly  enlarged,  as  shown  in  Fig.  137.  The 
bodies  were  a  dark  blue-black.  Aside  from  the  excessive  size  of  one 
and  the  color  of  both,  they  appeared  perfectly  healthy.  No  signs  of 
disease  were  observed  in  any  part  of  the  genital  system  or  else- 
where. Neither  the  cause  nor  the  significance  of  the  condition  was 
apparent.  It  is  probably  a  mere  "sport"  without  relation  to  sexual 
health  or  efficiency. 


Fig.  137 — Corpora  Lutea  of  Pregnancy.     For  comparison  with 
Cystic  Corpora  Lutea. 

/,  '^Adherent  ovary  ;    2,  corpus  nigrum  of   pregnancy  ;   j,  corpus  luteum  of 

pregnancy  ;  7,  mate  to  j  ;  5,  6,  corpora  lutea  of  preguancy  ;  8, 

enlarged  corpus  nigrum  ;  9,  10,  twin  corpora  lutea  ; 

12,  fresh  corpus  luteum. 

12.    Parovarian  Cysts 

Cysts  occur  now  and  then  in  close  proximity  to  the  ovaries,  ap- 
parently due  to  cystic  changes  in  remnants  of  the  Wolffian  bodies 
or  of  the  Wolffian  ducts.  In  the  mare,  as  illustrated  in  Fig.  70, 
Chapter  XI,  these  cysts  may  become  a  menace  to  the  health  or  to 
the  life  of  the  animal.  This  I  have  not  observed  in  the  cow  al- 
though it  may  evidently  occur.  Instead  I  have  observed  usually 
small  coiled  tubular  cysts  without  known  significance  for  the  ani- 
mal. Their  chief  interest  lies  in  their  close  proximity  to  the  ovi- 
ducts and  their  confusing  likeness  to  hydrosalpinx,  which  may  lead 
the  veterinarian  to   pronounce  a  perfectly  fertile   animal  incuuably 


426 


Diseases  of  the  Genital  Organs 


sterile.  They  are  to  be  differentiated,  so  far  as  my  collection  indi- 
cates, by  the  fact  that  in  the  cow  hydrosalpinx  usually  involves  the 
entire  length  of  the  oviduct  and  presents  the  other  characters  de- 
scribed under  that  heading.  The  parovarian  cysts  are  usually  small 
— much  smaller  than  the  hydrosalpinx  generally — and  can  be  picked 
up  in  the  mesosalpinx.  Careful  palpation  should  recognize  the 
healthy  tube  not  far  away,  enabling  one  to  differentiate  the  two 
structures. 

B.  Tubal  Infections' 

In  cattle  the  diseases  of  the  oviducts  constitute  a  very  fer- 
tile cause  of  sterility  and  play  an  unknown  role  in  the  oc- 
currence of  abortion.    The  oviducts  constitute  highly  com- 


FiG.  138 — Cross  Section  of  Normal  Oviduct  Near  the  Ampulla. 
Showinj^  the  Number  and  Coiiiplexily  of  lli«.'  Mucous  I'olds. 

plex  anatomo-physiologic  barriers  between  the  peritoneal 
and  uterine  cavities.  Technically,  the  peritoneal  cavity  of 
the  female  communicates   with  the  exterior  through  the 

'For  the  normal  and  pathologic  histology  and  for  the  bacteriology 
of  the  oviducts,  I  am  indebted  chiefly  to  the  work  of  Dr.  Herbert  L. 
Gilman,  graduate  student,  and  to  my  colleague,  Dr.  C.  M.  Carpenter. 


Tubal  Infections 


427 


Fig.  139—  Section  of  Normal  Oviduct  near  the  middle. 


Fig.  140— Section  of  Normal  Oviduct  near  the  Uterine  End. 

Showing  the  Simpler  Mucous  Folds  and  the 
Thickness  of  the  Muscular  Coat. 


428  Diseases  of  the  Genital  Organs 

genital  tube,  with  the  oviducts  interposed  as  highly  com- 
plex, sinuous,  narrow  tubules.  While  the  oviducts  are 
highly  efficient  in  preventing  the  migration  of  infection 
from  the  uterus  and  more  external  areas  into  the  peritoneal 
cavity,  the  same  complexity  makes  of  them  a  lodging-place 
for  infection  which,  once  attained,  is  unusually  refractory 
to  dislodgment  by  physiologic,  medicinal,  or  surgical  agen- 
cies. Since,  in  probably  more  than  90  per  cent,  of  cases  of 
infection  in  the  oviducts,  the  condition  is  bilateral,  the  du- 
plication of  ovaries  and  oviducts  avails  little ;  when  disease 
in  one  oviduct  constitutes  an  insurmountable  obstacle  to 
conception,  there  are  nine  chances  in  ten  that  the  other  tube 
is  likewise  barred.  Consequently  tubal  infection  generally 
closes  permanently  the  reproductive  career  of  the  animal. 
The  clinician  and  the  animal  husbandman  are  further  baf- 
fled in  the  present  state  of  knowledge  by  the  difficulty  in 
many  cases  of  making  an  early  diagnosis,  causing  incurable 
animals  to  be  held  for  long  periods  at  great  economic  loss 
before  the  character  of  the  disease  is  clearly  revealed.  The 
anatomic  and  histologic  lesions  caused  by  tubal  infection 
are  endless  in  variety.    Three  outstnding  types  occur. 

1.    Salpingitis  Unaccompanied  by  Enlargement  of  the 

Ducts  of  a  Degree  Clinically  Recognizable  by 

Palpation,  or  Macroscopically  Visible 

upon  Post-Mortem  Examination 

Salpingitis,  or  inflammation  of  the  oviducts,  without  ma- 
terial enlargement,  is  the  commonest  and  most  important 
type  of  disease  of  these  organs.  Ordinarily  the  infection 
does  not  cause  a  sufficient  degree  of  enlargement  to  enable 
the  veterinarian  to  make  a  diagnosis  by  palpation  per  rec- 
tum. Upon  post-mortem  inspection,  the  oviduct  shows  little 
macroscopic  evidence  of  disease.  The  principal  clinical  evi- 
dences of  salpingitis  are  persistent  sterility  without  palpable 
lesions  in  the  genital  tract,  as  a  rule  associated  with  cystic 
degeneration  of  the  corpus  luteum,  with  irregular  estrual 
cycles,  and  later  with  adhesion  of  the  pavilion  of  the  tube  to 
the  ovary. 


Salpingitis  429 

Cystic  degeneration  of  the  corpus  luteum  has  ah-eady 
been  discussed  under  "The  Diseases  of  the  Ovary."  It  is 
not  certain  that  cystic  degeneration  of  the  corpus  luteum 
occurs,  except  with  salpingitis,  although  it  cannot  be  proven 
that  salpingitis  is  the  sole  cause.  It  appears,  however,  that 
salpingitis  is  at  least  the  predominant  cause.  When  the 
ovisac  is  about  to  rupture,  it  is  believed  that  the  pavilion  of 
the  tube  invests  it,  with  the  ostium  abdominale  in  proximity 
to  the  ovisac.  When  ovulation  occurs,  infection  may  ap- 
parently escape  from  the  oviduct,  invade  the  crater  left  be- 
hind by  the  rupture,  and  set  up  disease,  which  eventually 
brings  about  the  destruction  of  the  yellow  body.  The  de- 
struction of  the  corpus  luteum  by  cystic  degeneration  does 
not  cause  the  sterility,  but  the  infection  which  exists  in  the 
oviduct  causes  alike  the  sterility  and  the  cystic  degeneration 
of  the  corpus  luteum.  It  follows,  therefore,  that  cystic  de- 
generation of  the  corpus  luteum  may  occur  in  spite  of  con- 
ception :  that  is,  spermatozoa  may  be  able  to  live  in  the  in- 
fected tube  and  fertilize  the  ovum,  which  may  be  able  to 
pass  through  the  infected  oviduct,  reach  the  uterine  cavity, 
and  develop.  As  a  rule,  however,  cystic  degeneration 
of  the  corpus  luteum  does  not  occur  in  pregnancy. 
From  my  abattoir  investigations,  I  would  estimate  that 
not  more  than  one  or  tw^o  per  cent,  of  corpora  lutea 
of  pregnancy  suffer  from  cystic  degeneration.  Perhaps 
the  facts  would  be  more  clearly  expressed  by  stating 
that,  when  the  oviduct  is  so  virulently  and  abundantly  in- 
fected that  the  infection  will  escape  from  the  tube  and  in- 
vade the  freshly  ruptured  ovisac,  the  spermatozoa,  and  the 
non-fertilized  or  fertilized  ovum  will  probably  be  destroyed. 
Sometimes,  however,  the  spermatozoon  and  ovum  run  the 
gauntlet  of  the  infected  tube  although  the  crater  of  the  ovi- 
sac is  invaded.  Then  follows,  at  least  in  some  cases,  cystic 
destruction  of  the  corpus  luteum  of  pregnancy,  with  recur- 
rence of  estrum  in  the  pregnant  animal.  The  cystic  degen- 
eration of  the  corpus  luteum  interrupts  more  or  less  seri- 
ously the  estrual  cycle.  Sometimes  the  estrual  period  will 
return  within  seven  to  fifteen  days ;  sometimes  the  cycle  may 


430  Diseases  of  the  Genital  Organs 

be  prolonged  so  that  the  estrum  does  not  recur  for  thirty 
or  more  days.     In  some  cases  the  estrum  is  comparatively 
regular.     The  clinical  recognition  of  the  cystic  corpus  lu- 
teum  has  already  been  discussed  in  dealing  with  the  ovary. 
When  pavilionitis  becomes  established,  with  adhesions  of 
the  pavilion  to  the  ovary,  the  diagnosis  of  salpingitis  be- 
comes positive.     So  far  as  known,  adhesions  of  the  ovary 
within  the  pavilion  must  be  attributed  to  salpingitis.     The 
clinical  recognition  of  such  adhesions  is  usually  simple.  The 
operator  should  pick  up  the  ovary  per  rectum  and  pass  the 
index  finger  into  the  ovarian  pocket  in  front  of  the  gland. 
If  any  adhesions  are  present,  they  are  readily  detected  in 
the  earlier  stages  as  delicate  threads  which  may  be  torn 
asunder  with  slight  pressure.    The  inflammation  gradually 
extends,  the  adhesive  bands  grow  in  volume  and  number, 
and,  if  the  disease  is  very  severe,  the  ovary  becomes  com- 
pletely and  firmly  adherent  within  the  pavilion  and  within 
the  ovarian  pocket,  or  bursa.     The  ovary  becomes  masked 
so  that  it  can  not  be  palpated  directly,  but  only  through  its 
adherent  covering.     It  is  then  either  very  large,  owing  to 
cystic  degeneration  of  the  corpus  luteum,  or,  if  of  long 
standing,  is  small,  hard,  sclerotic,  and  deeply  buried  in  the 
adhesions,  where  in  some  cases  it  is  recognized  only  with 
difficulty.     The  cystic  degeneration  of  the  corpus  luteum, 
the  erratic  estrual  cycle,  the  recognition  of  the  pavilionitis 
as  evidenced  by  the  adhesions,  with  the  persistent  sterility, 
each  justifies  a  diagnosis  of  salpingitis;  when  two  or  more 
of  these  are  taken  collectively,  the  diagnosis  is  rendered 
positive.    The  diagnosis  may  be  complicated  and  hampered 
by  the  presence  of  other  lesions  of  a  gross  character  and 
readily  recognizable. 

Salpingitis  is  frequently  associated  with  cervicitis  in  a 
confusing  manner.  When  cervicitis  of  an  intense  type  is 
rampant  in  a  herd  (I  have  seen  it  involve  GO  to  75  per  cent, 
of  large  herds)  salpingitis  eventually  forces  the  slaughter 
of  a  discouraging  number  of  cows  after  the  visible  cervicitis 
has  been  brought  under  control.  Whether  the  cervicitis 
caused  the  salpingitis  or  vice  versa,  or  whether  the  two  in- 


Salpino^ifis 


431 


Fig.  141— Highly  Mag-nified  Section  of  Normal  Mucous 
Fold  of  Oviduct. 


Fig.  142— Section  of  Oviduct  from  a  Six-Weeks-Old  Calf. 
Showing  the  Comparative  Thickness  of  the  Mucosa. 


432  Diseases  of  the  Genital  Organs 

fections,  ordinarily  identical,  arise  simultaneously  from  a 
common  center,  can  not  be  stated.  Judging  from  clinical 
observation  in  a  few  herds,  it  appears  that  the  source  of  the 
infection  in  these  notable  outbreaks  was  the  herd  bull,  and 
that  the  infection  was  transmitted  in  coitus,  attacking  pri- 
marily the  cervix  and,  before  that  was  brought  under  con- 
trol, invading  secondarily  the  oviducts.  It  seems  clear  that 
not  all  cases  of  salpingitis  are  explainable  upon  such  a  hy- 
pothesis. Frequently  heifers  are  absolutely  sterile  from 
salpingitis,  though  served  by  bulls  which  appear  genitally 
sound  and  to  which  other  females  have  been  bred  without 
exhibiting  clinical  evidences  that  they  are  dangerous  car- 
riers of  infection. 

The  oviducts  are  narrow,  tortuous  ducts  about  21  to  28 
mm.  long,  leading  from  the  ovaries  to  the  corresponding 
uterine  horns.  They  serve  as  a  path  for  the  passage  of 
spermatozoa  to  the  pavilion  and  as  excretory  ducts  in  the 
conveyance  of  the  ova  from  the  ovaries  to  the  uterus.  Each 
tube  is  rather  loosely  invested  by  a  fold  of  the  peritoneum 
derived  from  the  broad  ligament,  which  is  called  the  meso- 
salpinx. It  is  divided  into  a  broad,  funnel-shaped,  fimbri- 
ated end,  or  pavilion,  a  constricted  neck,  an  ampulla  of  con- 
siderable diameter,  and  a  narrow  isthmus  at  the  uterine  end. 
At  the  bottom  of  the  pavilion,  is  a  very  small  opening,  the 
ostium  abdominale,  through  which  the  lumen  of  the  tube 
opens  into  the  peritoneal  cavity.  Here  exist  two  unusual 
anatomical  conditions — a  break  in  the  continuity  between  a 
gland  and  its  excretory  duct,  and  an  opening  between  a 
serous  cavity  and  the  exterior.  From  this  constriction,  the 
tube  becomes  distended  to  about  3  to  5  mm.  in  diameter,  to 
form  the  ampulla,  and  from  here  to  the  uterine  end  gradu- 
ally diminishes  to  0.8  to  1  mm.  at  the  isthmus. 

The  epithelium  is  pseudo-stratified.  The  mucosa  is  thrown 
into  longitudinal  wrinkles  or  folds,  lined  by  a  pseudo-strati- 
fied epithelium,  which  increase  in  height  and  number  from 
the  uterine  to  the  abdominal  ends  and  are  without  glands. 
At  the  uterine  end  there  are  usually  four  or  five  folds,  com- 
paratively low  and  broad,  which  do  not  branch.     Toward 


Salpingitis 


433 


the  ampulla,  however,  they  increase  in  number  and  height, 
with  the  formation  of  numerous  secondary  folds,  so  that  at 
the  ampulla  the  otherwise  broad  lumen  becomes  almost  oc- 
cluded. At  the  fimbriated  end,  the  folds  widen  and  are  con- 
tinued out  on  the  free  ends  of  the  fimbriae,  forming  ridges 
which  branch  freely,  giving  the  pavilion  a  more  or  less 
honeycombed  appearance.  Not  infrequently  one  finds  the 
folds  ramifying  elaborately,  particularly  at  their  bases, 
forming  cavities  lined  by  a  sort  of  flattened  stratified  epi- 
thelium, sometimes  even  attaining  the  appearance  seen  in 
Fig.  143,    These  cavities  are  also  found  in  chronic  catarrhal 


Fig 


143— Normal  Section  of  Oviduct  Showing    the   Formation 
Cyst-Like  Cavities  by  Coalescence  of  the  Folds. 


of 


salpingitis,  but  usually  in  greater  numbers  and  accompanied 
by  other  pathological  changes.  The  superficial  layer  of  the 
epithelium  consists  of  tall  cells,  most  of  which  are  ciliated, 
though  there  is  much  difference  of  opinion  as  to  the  propor- 
tion of  the  latter.  In  older  animals,  there  are  but  two  or 
three  layers  of  cells  under  the  superficial  one ;  while  in  young 
28  . 


434 


Diseases  of  the  Genital  Organs 


calves  (six  weeks)  the  layers  are  very  numerous,  and  in 
some  the  mucosa  is  so  thick  that  there  is  little  or  no  space 
between  the  individual  folds  and  the  lumen  is  narrowed 
considerably,  as  in  Fig.  142.  The  muscular  wall  is  formed 
of  two  layers  of  smooth  fibers,  a  broad,  inner,  circular,  and 
a  thin,  outer,  longitudinal  layer.  A  third  inner  layer  of  lon- 
gitudinal fibers  and  bundles  is  seen  in  most  sections,  espec- 
ially near  the  uterine  end,  either  as  a  distinct  layer  or  in 
crescent-shaped  bundles,  as  in  Fig.  144. 


Fig.   144- -Chronic  Catarrhal  Salping:iti8.  with   a  Distinct  Crescent- 
Shaped  Inner  Longitudinal  Muscular  Coat. 

So  far  as  known,  all  inflammatory  changes  in  the  oviducts 
are  due  to  bacterial  invasion.  In  the  milder  forms  of  sal- 
pingitis the  mucosa  alone  is  affected  ;  in  the  severer  types  the 
process  spreads  to  the  deeper  layers  and  even  to  the  serosa. 
In  the  former  case  there  is  congestion,  some  exudation  into 
the  basement  membrane,  local  loss  of  cilia,  and  frequently 
more  or  less  desquamation  of  the  superficial  epithelium.  In 
the  deeper  layers  there  may  be  hyperaemia,  slight  exudation 


Salpingitis 


435 


Fig.  145 — Chronic  Catarrhal  Salping-itis,  Showing  the  Epithelium 
About  to  be  Cast  Oflf,  and  Edema  of  the  Wall, 


Fig.  146— Chronic  Catarrhal  Salpingitis,  with  Marked  Edema 
of  the  Wall. 


4^6  Diseases  of  tlie  Geuital  Organs 

and  more  or  less  swelling  of  the  parts.  There  is  usually  a 
profuse  exudate  in  the  lumen.  The  mucosa  may  be  thick- 
ened by  a  small-celled  infiltration  and  the  epithelium  show 
cloudy  swelling,  fatty  degeneration,  desquamation,  or,  as  is 
often  the  case,  total  destruction.  Owing  to  cellular  infiltra- 
tion and  the  formation  of  granulation  tissue,  the  folds  may 
become  thickened  and  often  fuse,  with  the  production  of 
cyst-like  cavities  lined  by  epithelium.  In  some  cases  the 
greatly  increased  blood  vessels  show  hyaline  or  amyloid  in- 
filtration of  their  walls,  as  shown  in  Fig.  151.  The  muscular 
coat  often  shows  hypertrophy  and  small-celled  infiltration, 
either  diffusely  or  in  collected  areas. 

The  exudate  into  the  lumen  is  probably  discharged  into 
the  uterus,  where  it  may  cause  metritis  or  cervicitis.  If  the 
secretion  is  unable  to  escape  readily  in  that  direction,  either 
through  swelling  of  the  parts  or  atresia  of  the  uterine  osti- 
um, it  is  discharged  on  the  fimbria  or  ovary,  with  subse- 
quent inflammation  of  the  parts.  Here  it  may  produce  a 
simple  serous  inflammation,  though  more  often  it  assumes  a 
fibrinous  character,  with  the  resulting  formation  of  adhe- 
sions, fibrinous  strands  between  the  fimbriae  and  ovary,  or 
closure  of  the  ostium  abdominale.  Not  infrequently  the  en- 
tire pavilion  becomes  adherent  to  the  ovary,  in  which  case 
there  may  result  a  tubo-ovarian  cyst  or  abscess.  If  the  dis- 
ease spreads  farther,  there  may  occur  a  fibrinous  peri-sal- 
pingitis  with  the  formation  of  numerous  fibrous  strands 
running  from  the  tube  to  the  neighboring  parts  of  the  broad 
ligament.  With  closure  of  both  the  ostium  abdominale  and 
uterine  ostium,  the  result  is  very  often  an  accumulation  of 
the  contents,  with  the  formation  of  hydrosalpinx  or  pyosal- 
pinx. 

The  lesions  may  vary  greatly  according  to  intensity  and 
duration.  In  the  simpler  type  of  the  early  stages,  the  mu- 
cosa is  swollen,  congested,  and  the  seat  of  small-colled  infil- 
tration. The  lumen  may  contain  fibrinous  exudate  mingled 
with  desquamated  epithelium,  as  shown  in  Fig.  150.  The 
desquamation  involves  loss  of  cilia.  With  added  severity  of 
the  infection,  the  epithelial  layers  are  destroyed  one  alter 


Salpi7igitis 


437 


Fig.  147— Chronic   Catarrhal  Salpingitis.     The  Mucous  Folds  have 
been  Destroyed  and  the  Lumen  of  the  Tube  Filled  with  Debris. 


Fig.  148 — Chronic  Catarrhal  Salpingitis. 
With  Well  Advanced  Occlusion  of  the  Lumen  of  the  Tube. 


438  Diseases  of  the  Genital  Organs 

the  other  until  all  disappear.  The  destruction  of  the  epithe- 
lium ordinarily  occurs  first  at  the  summits  of  the  longitudi- 
nal folds  and  last  at  their  bases.  The  denuded  mucous  folds 
tend  to  adhere  and  to  cause  thereby  small  cavities  between 
their  bases,  lined  with  epithelium. 

In  bacteriologic  studies  of  over  eighty  pairs  of  oviducts, 
Gilman  found  that  a  streptococcus  of  the  viridans  group 
was  the  dominant  organism,  staphylococcus  albus  and  au- 
reus were  common,  and  in  one  instance  only  did  he  recognize 
an  organism  closely  resembling  B.  abortus. 

The  prognosis  is  virtually  hopeless.  In  more  than  90  per 
cent,  of  cases,  the  infection  is  bilateral.  It  is  possible  that 
in  some  cases  the  tubes  recover  spontaneously,  but  there  is 
no  evidence  which  fully  justifies  one  in  asserting  that  this 
occurs.  The  duct  is  beyond  surgical  interference  under  any 
known  technic,  and  there  is  no  known  medicinal  remedy. 

The  prevention  of  salpingitis  must  be  based  upon  the 
avoidance  of  infection  in  other  parts  of  the  genital  tract. 
The  infection  probably  advances  into  the  oviduct  from  the 
cervix  and  uterus.  At  least  we  know  clinically  that,  in  herds 
where  cervicitis  is  common,  a  large  proportion  of  the  ani- 
mals become  incurably  sterile  from  salpingitis,  in  spite  of 
the  fact  that  the  cervicitis  may  almost  always  be  overcome. 
If,  therefore,  salpingitis  is  to  be  prevented,  it  is  essential 
that  the  measures  taken  shall  be  timely.  Many  heifers,  suf- 
fering from  salpingitis  prior  to  breeding  age,  are  conse- 
quently incurably  sterile.  So  far  as  can  be  determined  now. 
such  infection  in  heifers  should  be  referred  to  the  nursery 
period  and  its  prevention  based  upon  keeping  the  calf  in  a 
high  state  of  health.  The  belief  has  been  expressed  else- 
where that,  during  dysentery  or  pneumonia  in  calves,  or 
when  slighter  infection  exists  in  the  alimentary  or  pulmo- 
nary tract,  bacteria  escape  and,  entering  the  blood  stream, 
become  lodged  in  the  genital  tract,  for  which  they  have  an 
affinity.  Later,  when  the  animal  comes  to  breeding  age,  it 
seems  perfectly  clear  at  present  that  an  infection  which  may 
bring  about  salpingitis  may  be  carried  by  the  bull  and  intro- 
duced during  coitus.     This  may  not  interfere  with  concep- 


Solpi7igitis 


439 


Fig.  149— Chronic  Catarrhal  Salpingitis. 

With  Almost  Total  Occlusion.     Vestiges  of  tube  lumen  are  shown 

by  two  small  black  areas  bordered  by  wliite. 


Fig.  150— Highly  Magnified  Fold  of  the  Mucosa  in  the  Acute  Stages 
of  Inflammation,  Showing  Congestion,  Exudation,  etc. 


440 


Diseases  of  the  Geyiital  Organs 


Fig.  151 — Highly   Magnified   Fold   of  the   Mucosa  in 

Chronic  Catarrhal  Inflammation. 

Showing  Destruction  of  the  Epithelium,  thickening  by  newly-formed 

Connective  Tissue,  and  Amyloid  or  Hyaline  Infiltration 

of  the  Blood  Vessels. 


lM(,.   151     Section  of  the  Tube  Wall  in  Hydrosalpinx. 
vSliowing  the  SligliHv  Changed  Ivijitheliuni,  an<l  llu-  I.oose,  Mcuihranou 
Character  of  the  Wall. 


Salpingitis 


441 


tion,  but  may  cause  salpingitis  during  pregnancy,  with  in- 
curable sterility,  while  the  uterus  contains  a  living  and  ap- 
parently healthy  fetus.  In  such  cases  the  animal  may  calve 
apparently  well  and  appear  to  be  sound  during  her  puerperal 
period,  but  is  bound  to  be  absolutely  and  incurably  sterile. 

More  frequently  salpingitis  follows  cervicitis  and  metri- 
tis. It  is  especially  apt  to  follow  retained  afterbirth.  Ac- 
cordingly it  is  essential,  if  salpingitis  is  to  be  prevented, 
that  the  genital  tube  shall  be  closely  watched  during  the 
puerperal  period,  and  any  infection  present  in  the  cervix  or 


Fig   153— Section  of  Part  of  the  "Wall  in  an  Old  Case 

of  Tubercular  Salpingitis. 

Near  the  center  of  the  section  are  seen  three  cavities  lined  with  epithelium, 

which  have  resisted  the  necrotic  processes. 

uterus  promptly  overcome  if  possible.  The  veterinarian 
and  breeder  should  clearly  understand  that  a  retained  after- 
birth is  a  perilous  thing  for  the  integrity  of  the  oviducts. 
Consequently,  retained  afterbirth  should  be  watched,  not 
only  from  the  standpoint  of  saving  the  life  of  the  animal  or 
of  merely  preventing  a  severe  metritis,  but  because  of  the 


442 


Diseases  of  the  Geniial  Organs 


Pavilionitis 


443 


danger  from  salpingitis  owing  to  the  infection  extending 
from  the  uterine  cornua  forward  into  the  tubes. 

Treatment.  Since  the  prognosis  is  so  nearly  hopeless, 
there  is  but  little  which  can  be  suggested  in  the  way  of 
treatment,  once  the  disease  has  become  established.  If  it 
can  be  determined,  or  if  it  can  be  reasonably  hoped  that  the 
disease  is  unilateral  and  is  causing  irregularity  in  sexual 
life,  the  offeding  oviduct,  with  the  ovary,  may  be  removed. 
If  the  ovary  and  oviduct  are  sufficiently  mobile,  it  may  be 
possible  in  some  cases  to  operate  through  the  vagina,  but  as 


Fig.  155  — Adherent  Ovary.    Cow.    Dorsal  surface  viewed  from  behind. 
L,  Ovarian  ligament  ;    C,  ovary  ;  Ov,  oviduct. 


444 


Diseases  of  the  Genital  Orgaris 


a  general  rule  laparotomy  upon  the  side  of  the  animal  where 
the  diseased  tube  is  located  is  safer.  In  performing  laparoto- 
my, the  incision  should  be  made  in  the  middle  of  the  flank. 
If  it  is  attempted  to  operate  high  up  in  the  flank,  it  is  well- 
nigh  impossible  to  draw  the  ovary  and  duct  out  through  the 
laparotomy  wound.  It  is  difficult  even  to  carry  out  the  oper- 
ation when  the  laparotomy  wound  is  in  the  middle  part  of 
the  flank.  When  the  operation  is  decided  upon,  care  should 
be  taken  to  remove  the  entire  oviduct  and  to  make  the  am- 
putation through  the  apex  of  the  cornu,  avoiding  as  far  as 


Fic.  156  -Adhesion  of  Right  Oviduct  to  Ovary.  Double  Left 
Ovary  with  Pregnancy. 
/,  Vagina  ;  2,  fetal  iiieinbraiics  in  k-fl  horn  ;  j,  ,\  transverse  septa  in 
uterine  cavity  ;  ./,  corpus  hiteuni  in  median  jwrtion  of  left  ovary  ;  5,  lateral 
portion  of  left  ovarv  ;  6,  i)e(Uuiciilalc(l  old  corpus  hiteutn  which  had  been 
iniiierfcctly  dislodged  ;  7,  rij,dit  a.llurt-nt  ovary  ;  ,s',  ostium  ahdoininale  of 
oviduct. 


Pyosalpi7ix  445 

possible  escape  of  the  infection  into  the  peritoneal  cavity. 
Consequently  it  is  best  to  secure  the  cornu  carefully  upon 
either  side  of  the  point  of  the  intended  amputation  and  take 
ample  precautions  against  escape  of  any  infection  into  the 
peritoneal  cavity.  The  stump  of  the  cornu  should  be  closed 
as  in  the  operation  for  appendicitis  in  man.  That  is,  the 
mucosa  should  be  sutured  or  ligated  and  pushed  back  into 
the  lumen  of  the  horn,  and  then  the  serosa  and  musculosa 
drawn  together  over  the  mucosa  with  durable  gut  sutures. 
The  operation  of  spaying  has  been  described  in  Chapter  XI. 

2.    Pyosalpinx 

In  the  simple  salpingitis  which  is  described  in  the  pre- 
ceding paragraph,  no  appreciable  amount  of  pus  is  formed. 
Sometimes,  however,  there  is  a  considerable  volume  of  pus 
formed  in  the  oviduct,  which  definitely  distends  it,  rendering 
it  palpable.  In  some  cases  the  duct  is  moderately  enlarged 
and  the  walls  very  thick,  hard,  and  readily  palpable  per  rec- 
tum. In  other  cases  which  I  have  encountered,  there  is  a 
considerable  distension  of  the  oviduct,  its  walls  become  thin 
and  paretic,  and  the  tube  becomes  soft  and  fluctuant.  In 
such  cases,  as  a  rule,  at  least  in  the  specimens  in  my  collec- 
tion, the  pavilion  of  the  tube  is  adherent  about  the  ovary  or 
to  the  mesosalpinx  or  mesometrium  and  the  pus  surrounds 
the  ovary  more  or  less  completely,  and  causes  its  partial  or 
total  necrosis. 

In  a  third  group,  which  is  illustrated  in  Figures  157,  158, 
a  large  tubo-ovarian  abscess  forms,  sometimes  containing 
eight  to  ten  or  fifteen  ounces  of  thick  pus.  In  these  cases, 
neither  ovary  nor  tube  is  recognizable,  but  in  their  stead  is 
a  great  sclerotic  abscess  with  very  heavy,  thick  walls.  In 
many  cases  the  abscess  does  not  become  firmly  adherent  to 
other  organs  and  does  not  point  and  break.  In  some  of  my 
specimens,  where  adhesions  are  very  extensive,  it  seems 
probable  that  in  the  complex  abscessation  there  have  been 
tubo-ovarian  abscesses  which  have  emptied  into  the  neigh- 
boring organs,  but  the  destruction  has  been  so  great  that 
the  question  can  not  be  clearly  determined. 


446 


Diseases  of  the  Genital  Organs 


The  prognosis  for  pyosalpinx  and  for  tubo-ovarian  ab- 
scess is  necessarily  hopeless,  so  far  as  the  diseased  side  is 
concerned.  It  is  highly  important  that  a  careful  diagnosis 
should  be  made,  so  that  pyosalpinx,  or  tubo-ovarian  abscess, 
shall  not  be  mistakenly  treated  for  some  other  lesion,  at 
great  peril  to  the  animal.  In  some  tubes  distended  with 
pus,  and  perhaps  in  some  cases  of  large  tubo-ovarian  ab- 
scesses, the  w^alls  could  be  readily  ruptured  by  pressure  per 
rectum,  causing  a  fatal  peritonitis.  Therefore  it  is  highly 
important  that  the  veterinarian  shall  not  mistake  tubo- 
ovarian  abscesses  for  ovarian  cysts  and  rupture  the  ab- 
scesses into  the  peritoneal  cavity,  with  fatal  results.  As  a 
general  rule,  the  prudent  veterinarian  will  let  pyosalpinx 
alone.  In  exceptional  cases,  where  the  pus  seems  to  be  well 
walled  off,  is  confined  to  one  side,  and  is  inhibiting  ovulation 


Imc.  157 — Tubo-Ovarian  Abscess.     Cow. 

/,  Vagina  and  cervix  seen  from  vi-ntral  side  ;   j,  Uft  utiriui-  cornii  ;   ,',  tuho- 

ovariaii  abscess  ;  ./,  cross  section  of  ovidiul  lilletl  with  pus. 


Pyosalpinx  447 

on  the  sound  side,  it  may  be  possible  to  remove  the  suppu- 
rating tube,  with  its  ovary,  by  laporatomy.  In  valuable 
breeding  animals  it  may  be  worth  while  to  take  the  risk  of 
such  an  operation.  The  technic  of  the  operation  would  natu- 
rally be  the  same  as  that  for  salpingitis  and  adherent  ovary, 
though  the  peril  to  the  animal  would  be  very  much  greater, 
and  the  owner  should  have  the  risks  thoroughly  explained 
prior  to  venturing  upon  so  hazardous  a  procedure. 


Fig.  158— Tubo-Ovarian  Abscess  with  Pelvic  Adhesions.     Horizontal 

section  through  top  of  uterus  viewed  from  above. 

/,    Cervix  ;    2,     sclerotic    uterus    with     pus     in    uterine    cavity  ;    j,     right 

ovary  ;    4,  cross  section   through   the    left  oviduct  at  tlie  ovary.      The 

figure  4  is  in  the  centre  of  large  hematoma  and  at  lower  border 

of  this  is  seen  pus ;  5,  left  ovary  completely  adherent. 


448 


Diseases  of  the  Genital  Organs 


3.    Hydrosalpinx  and  Dropsy  of  the  Pavilion  of  the 
Oviduct 

Hydrosalpinx,  which  is  comparatively  common  in  cattle, 
constitutes  one  of  the  common  causes  of  incurable  sterility 
in  heifers.  It  is  apparently  as  common  in  heifers  which 
have  never  conceived  as  it  is  in  cows.  The  period  of  inva- 
sion of  the  disease  in  heifers  is  not  definitely  known.  Prob- 
ably it  occurs  during  the  nursery  period  and  passes  unob- 
served until  breeding  age,  when  it  causes  sterility,  and  is 
then  recognized  by  clinical  examination.  The  disease  also 
arises  during  pregnancy,  although  how  frequently  can  not 


Fig.  159-  Cystic  Pavilion  of  the  Oviduct. 

(),  Ri^hl  ovary  ;  0\  k-ft  ovjiry  ;   /  t",  coriina  ;   L\  cystic  pavilion 
adherent  to  ovarv. 


Hydrosalpinx  and  Dropsy  of  the  Pavilion  of  the  Oviduct    449 


Fig.  160 — Cystic  Oviducts  and  Corpus  Luteum. 

A,  Dorsal  view  ;  B,  ventral  view. 
/,  Uterine  body  ;  2,  cornu  ;  j,  cystic  corpus  luteum  of  right  ovary,  sec- 
tioned ;  4,  girlde  of  lutein  tissue  :  5,  sectioned  left  ovary,  cystic  ;  6,  cystic 
left  oviduct  ;  7,  ostium  abdominale  of  oviduct  ;  A',  ventral  surface  of  right 
ovary,  with  cystic  corpus  luteum  ;  9,  cystic  right  oviduct,  buried  underneath 
right  cornu  and  ovary.  29 


450  Diseases  of  the  Genital  Ors;ans 

be  determined.  I  have  not  observed  bilateral  hydrosalpinx 
in  a  pregnant  cow,  either  clinically  or  in  the  abattoir.  In 
the  sow,  however,  I  have  one  example,  shown  in  Fig.  161, 
which  indicates  very  clearly  that  the  disease  does  occur  in 
the  pregnant  sow,  and  presumably  in  pregnant  animals  of 
all  species.  Frequently  it  follows  retained  afterbirth  and 
other  types  of  puerperal  infection.  Since  hydrosalpinx  is 
almost  always  bilateral,  its  chief  clinical  manifestation  is 


I'iG.  1 6 1— Extreme  Bilateral  Hydrosalpinx. 
/,   /,   Section   through  cystic,  adherent  ovaries  (cystic   dejieneration    of 
corpus   luteuni)  ;    2,    enormously    distended   oviduct.       About    -^    of    total 
lenj,nh  lies  underneath   the  portion  shown  ;  j,  section  through  the  smaller 
oviduct. 

absolute  sterility  of  the  patient.  The  disease  assumes  a  va- 
riety of  types.  Generally,  when  hydrosalpinx  is  established, 
adhesion  of  the  ovary  within  the  pavilion  of  the  tube  has  al- 
ready occurred.  The  mesosalpinx  is  also  commonly  adher- 
ent to  the  ovary,  as  shown  in  Figs.  154,  155  and  156,  so  that 
the  cystic  oviduct  is  thrown  into  a  convoluted  mass  in  front 
of  and  lateral  to  the  ovary,  and  in  some  cases  above  the 


Hydrosalpinx  ayid  Dropsy  of  the  Pavilion  of  the  Oviduct    451 

gland.  In  other  instances,  the  margin  of  the  pavilion  ad- 
heres to  the  ovary  while  the  general  mucous  surface  of  the 
funnel  remains  free.  It  then  participates  in  the  cystic  dis- 
tension and  in  some  cases  becomes  enormously  enlarged,  as 
shown  in  Fig.  159.  In  other  types  of  hydrosalpinx,  the  tube 
and  pavilion  remain  perfectly  free.  The  ostium  abdominale 
of  the  oviduct  becomes  occluded  and  the  pavilion  of  the  ovi- 
duct recurved  over  the  ampulla,  leaving  a  knob-like  enlarge- 
ment at  the  end  of  the  oviduct.  It  is  still  adherent  by  one 
or  two  fimbriae  to  the  lateral  end  of  the  ovary,  but  these 
fimbriae,  on  account  of  the  weight  of  the  oviduct,  may  be 
very  greatly  elongated  so  that  the  cystic  oviduct  may  drop 
far  forward  and  lie  lower  down  in  the  abdominal  cavity. 
In  order  that  this  may  occur,  the  mesosalpinx  must  also  be- 
come greatly  stretched  as  a  consequence  of  the  weight  of 
the  cystic  fluid.  Amongst  these  three  most  distinctive  types 
there  is  every  possible  variation.  The  condition  is  almost 
invariably  associated  with  either  a  cystic  degeneration  of 
the  corpus  luteum  or  a  fibrous  degeneration — sclerosis — of 
the  ovary  as  a  whole.  Presumably  these  changes  in  the . 
ovary  are  the  result  of  a  passage  of  infection  by  contact  into 
the  ovary,  generally  through  the  wound  caused  by  the  rup- 
ture of  the  ovisac  at  the  time  of  ovulation  prior  to  the  pe- 
riod of  complete  closure  of  the  oviduct. 

The  diagnosis  of  hydrosalpinx  should  be  based  upon  the 
enlargement  of  the  oviduct  as  described.  Sometimes  the 
cystic  condition  involves  chiefly  a  small  segment  of  the  ovi- 
duct; sometimes  it  involves  with  great  uniformity  the  en- 
tire length.  The  size  of  the  cystic  oviduct  will  vary  between 
a  trifling  enlargement  beyond  normal  up  to  three-quarters 
to  seven-eighths  of  an  inch  in  diameter  or  possibly  larger. 
The  length  of  the  oviduct  is  also  enormously  increased — at 
times  8  to  10  inches  long — especially  when  the  entire  duct  is 
free.  Extensive  adhesions  tend  to  restrain  the  duct  from 
becoming  greatly  elongated  and  throw  it  into  very  compli- 
cated convolutions.  A  cystic  condition  of  the  pavilion  is  to 
be  diagnosed  largely  by  its  extreme  softness  and  its  posi- 
tion as  related  to  the  ovary.     As  shown  in  Fig.  159,  the 


452  Diseases  of  the  Genital  Organs 

ovary  lies  behind  the  cj^stic  duct.  Sometimes  when  the 
duct  is  closely  convoluted  and  the  convolutions  held  firmly 
by  adhesions,  the  mass  may  be  mistaken  for  a  very  large 
ovary.  This  error  should  constantly  be  avoided.  The  cystic 
pavilion  also  is  frequently  mistaken  for  an  ovarian  cyst. 
This  is  an  unfortunate  error  because  it  leads  to  a  false  prog- 
nosis. Cystic  ovaries  are  not  hopeless,  but  cystic  distension 
of  the  pavilion  of  the  oviduct  is  beyond  remedy.  The  veteri- 
narian is  also  apt  to  err  when  the  oviduct  is  free  and,  owing 
to  extensive  degeneration,  drops  forward  beneath  the  ovary, 
as  indicated  in  Fig.  160,  where  it  is  detected  with  great  diffi- 
culty. In  one  instance  I  diagnosed  hydrosalpinx  upon  one 
side,  but  failed  to  detect  it  upon  the  other  side  because  the 
oviduct  was  enormously  enlarged  and  the  mesosalpinx  so 
elongated  that  the  oviduct  dropped  far  downward  and  for- 
ward beneath  the  gland.  The  result  was  that  an  incurably 
sterile  animal  was  retained  in  the  herd  for  about  a  year. 

Hydrosalpinx  is  bilateral  in  approximately  90  per  cent,  of 
cases.  Since  the  prognosis  is  utterly  hopeless,  so  far  as  the 
involved  tube  is  concerned,  it  follows  that  the  prognosis  of 
hydrosalpinx  in  general  is  very  bad.  In  some  cases  the  dis- 
ease may  be  confined  to  the  oviduct,  and  the  animal  may 
breed,  and  occasionally  does,  upon  the  sound  side.  In  such 
a  case  there  is  no  call  for  interference.  In  other  cases  the 
disease,  especially  when  complicated  with  a  large  cystic 
corpus  luteum,  may  inhibit  ovulation  upon  the  sound  side. 
Relief  may  be  had  in  such  instances  through  amputation  of 
the  diseased  tube  with  the  ovary.  The  veterinarian  needs 
to  be  very  careful  in  making  his  diagnosis  and  to  remember 
that  the  condition  is  nearly  always  bilateral.  Therefore  it 
is  essential  that  he  examine  both  sides  with  very  great  care. 
If  both  ducts  are  involved,  the  case  must  be  abandoned.  The 
operation  for  the  removal  of  the  tube  and  ovary  is  the  same 
as  described  in  the  preceding  paragraphs. 

4.    Cysts  in  the  Mesosalpinx 

Occasionally    one    finds    small    cysts    in    the    mesosalpinx.      Some- 
times they  are  located  about  the  ampulla  of  the  oviduct  and  are  due 


Uteriyie  Infections  453 

to  cystic  changes  in  remnants  of  the  Wolffian  bodies.  Since  clinically 
these  small  cysts  may  closely  resemble  hydrosalpinx,  they  should  be 
examined  with  very  great  care.  So  far  as  I  know,  they  are  never  of 
any  consequence  in  the  cow,  although  in  the  mare  they  may  become 
very  large  and  interfere  in  a  variety  of  ways  with  the  physical  well- 
being  of  the  animal,  as  already  related  in  Chapter  XI. 

C.   Uterine  Infections 

1.    The  Diseases  of  the  Uterus  of  the  Heifer  Calf  and 
Virgin  Heifer 

A.  Intra-Uterine  Infection  and  Endometritis 
Numerous  heifers,  arriving  at  breeding  age,  are  found  to 
be  absolutely  sterile.  In  many  of  these  cases  it  is  impossible 
to  determine  the  date  of  invasion.  Sometimes,  where  the 
records  are  defective,  conception  may  have  occurred  and 
abortion  has  followed  early,  though  the  embryo  was  not  of 
sufficient  size  to  be  recognized.  Sometimes,  probably,  the 
embryo  has  not  been  expelled,  but  has  broken  down  and  has 
been  absorbed.  Sometimes  the  infection  may  have  been 
transmitted  to  the  heifer  by  the  bull  in  coitus.  In  any  of 
these  cases  the  fundamental  clinical  fact  is  that,  so  far  as 
can  be  seen,  the  heifer  is  sterile  when  she  reaches  the  age 
for  breeding.  Upon  examining  such  an  animal,  little  may 
be  found  clinically  to  indicate  the  character  of  the  disease. 
The  genital  organs  appear  normal  upon  palpation.  Upon 
post-mortem  examination  of  such  animals,  the  uterus,  as 
well  as  the  oviducts,  which  have  already  been  discussed,  is 
found  to  contain  infection,  and  histologic  changes  have  oc- 
curred in  the  genital  mucosa.  If  the  heifer  is  kept  over  a 
long  period  of  time  and  repeatedly  bred  to  the  bull,  lesions 
gradually  develop  which  are  clinically  recognizable.  The 
first  of  these  is  an  enlargement  and  atony  of  the  uterus,  as 
shown  in  Fig.  162,  testifying  to  the  existence  of  endometri- 
tis. Clinical  examination  generally  reveals  also  the  pres- 
ence of  cervicitis  with  thickening  and  sclerosis  of  the  annu- 
lar mucous  folds  of  the  cervix.  These  deform  and  press 
aside  the  cervical  canal  so  that  it  is  difficult  to  pass  a  sound 


454 


Diseases  of  the  Genital  Organs 


or  other  instrument  into  the  uterine  cavity.  Eventually 
the  ovary  and  oviduct  participate  in  the  changes  which  be- 
come clinically  recognizable. 

The  diagnosis  of  endometritis  in  the  heifer,  pending  the 
enlarged  flabby  condition  of  the  uterus,  is  not  practicable 
except  for  the  history  of  sterility  and  the  absence  of  other 
evidences  of  disease.  In  this  respect  one  finds  it  impossible 
to  differentiate  between  endometritis  and  salpingitis.     As  a 


Fig.  162— Chronic  Endometritis  in  Five-Year-Old,  Non-Pregnant 

Heifer  which  had  Never  Conceived. 

/,  Cervix  ;  2,  cornua  ;    j,  small  right  ovary  ;  ./,  left  ovary  with 

large,  persistent  corpus  luteum. 


general  rule,  they  probably  coexist,  since  the  essential  differ- 
ence is  that,  when  the  disease  changes  are  limited  to  the  cer- 
vix and  uterus,  each  of  which  is  somewhat  amenable  to  in- 
terference, there  is  hope  for  the  breeding  power  of  the 
heifer.  The  principal  evidence  upon  which  one  may  tenta- 
tively differentiate  endometritis  from  salpingitis  is  by  the 
presence  or  absence  of  cystic  degeneration  of  the  corpus 
luteum  and  the  irregular  estrual  cycle  dependent  ujion  that 


Uterine  Infections 


455 


degeneration.  If  cystic  degeneration  of  the  corpus  luteum, 
with  irregular  estrual  cycle,  is  present,  salpingitis  may  be 
diagnosed  with  considerable  confidence.  At  the  same  time, 
endometritis  is  probably  present.  If,  along  with  the  per- 
sistent sterility,  the  corpus  luteum  does  not  undergo  cystic 
degeneration  and  the  estrual  cycle  is  regular,  one  may  be 
warranted  in  diagnosing  endometritis  or  cervicitis  without 


Fig.  163— Complete  Pelvic  Adhesions  with  Uterus,  Cornua,  Oviducts, 

and  Ovaries  Firmly  Bound  Together.     Heifer. 

/,  Cervix  ;  2,  uterine  body  ;  j,  cornua  ;  7,  left  ovary  with 

cystic  corpus  luteum. 

salpingitis,  and  a  more  favorable  prognosis  may  be  given. 

The  treatment  needs  to  be  based  on  disinfection  of  the 
uterine  cavity.  Admittedly  it  is  technically  impossible  to 
disinfect  the  uterine  mucosa  without  destroying  it,  but  there 
is  much  that  can  be  done  to  favor  disinfection  by  indirect 
methods.  Endometritis  is  almost  always  associated  with 
cervicitis  and  largely  dependent  thereon.    Not  only  does  the 


456  Diseases  of  the  Genital  Organs 

cervicitis  furnish  a  permanent  center  for  the  infection,  but 
the  swelling  of  the  annular  folds  of  the  cervix  compresses 
the  cervical  canal  and  interferes  with  the  proper  drainage  of 
the  uterine  cavity,  so  that  infected  secretions  are  held  back. 
Therefore  one  should  dilate  the  cervical  canal  in  order  to 
bring  about  improvement  of  the  cervix  itself  through  the 
application  of  antiseptics,  to  establish  a  practical  path 
through  w^hich  one  can  reach  the  uterus  to  disinfect  it,  and, 
more  important  still,  to  obtain  a  freer  opening  for  the  es- 
cape of  the  infection  from  the  uterine  cavity. 

The  dilation  of  the  cervical  canal  is  sometimes  exceed- 
ingly difficult  in  these  animals.  In  some  cases  I  have  found 
it  necessary  to  make  repeated  attempts  with  the  uterine 
dilators  before  succeeding  in  passing  through  the  cervical 
canal.  One  must,  therefore,  have  great  patience  and  per- 
severe in  the  work  until  the  object  is  attained.  Once  the 
dilator  has  passed  through  the  cervical  canal,  it  can  be 
gradually  dilated  by  opening  the  instrument.  One  should 
not  attempt  to  dilate  the  canal  completely  by  a  single  open- 
ing of  the  dilator,  but  should  open  it  for  a  time,  then  close 
it,  revolve  it  a  short  distance  upon  its  long  axis,  and  open 
it  again.  This  process  should  be  kept  up  until  pressure  has 
been  brought  to  bear  upon  every  part.  While  the  jaws  of 
the  dilator  are  forced  apart,  the  instrument  should  be  care- 
fully withdrawn  by  exerting  moderate  traction  so  that  the 
dilation  is  extended  throughout  the  length  of  the  canal. 
When  the  dilation  has  been  satisfactorily  completed,  the 
uterus  may  be  douched  and  the  re-flow  should  be  examined 
carefully  for  the  presence  of  muco-pus  or  other  evidence  of 
disease.  The  uterine  cavity  should  then  be  disinfected,  for 
which  purpose  2  per  cent.  Lugol's  solution  or  '  ^  per  cent, 
chlorazene  solution  may  be  used.  These  must  be  carefully 
drained  off  from  the  uterus. 

Probably  a  better  plan  for  disinfecting  consists  of  plac- 
ing in  the  uterus  a  heavy,  virtually  insoluble  disinfectant, 
such  as  iodoform  and  bismuth.  I  have  had  apparently  good 
results  from  a  heavy  suspension  of  iodoform  and  bismuth 
subnitrate  in  white  mineral  oil,  injected  (one  or  two  ounces) 


uterine  hifeciions 


457 


Fig.  164— Arrested  Excavation  of  Muellerian  Ducts  with 

Cystic    Uterus. 

A,  Viewed  from  above;  B,  ventral  view. 

/,  Cervix  ;  2,  body  of  uterus,  divided  by  transverse  septa  ;  j,  corni 

separated  from  uterine  body  by  septa  ;  4,  right  ovary  ; 

5,  left  ovary. 


458  Diseases  of  the  Genital  Orgajis 

into  the  uterus  and  left  there.  It  should  be  heated  to  the 
temperature  of  the  body  before  introducing.  It  remains 
in  the  uterine  cavity  for  ten  to  fifteen  days,  undergoing 
very  gradual  solution,  tending  constantly  to  disinfect  the 
uterine  cavity  and  at  the  same  time  exerting  a  favorable 
influence  upon  the  infection  in  the  cervix.  The  treatment 
may  be  repeated  several  times  and,  when  the  uterus  and 
cervix  seem  to  be  in  good  condition,  may  be  discontinued 
for  three  or  four  weeks  until  the  iodoform  and  bismuth 
have  disappeared.  The  animal  may  then  be  bred.  The 
heavy  suspension  of  iodoform  and  bismuth  in  oil  are  best  in- 
troduced with  a  metallic  syringe,  as  shown  in  Fig.  196.  The 
conical  nozzle  may  be  used,  inserted  into  the  end  of  the  small 
uterine  catheter,  and  the  suspension  forced  through  this 
into  the  uterus.  If  more  convenient,  the  long  curved  nozzle, 
which  closely  simulates  the  catheter  itself,  may  be  used  and 
the  suspension  injected  directly  into  the  uterine  cavity  with 
the  syringe. 

In  conjunction  with  the  injection  into  the  uterus,  any 
cervicitis  present  should  have  attention.  Sometimes  there 
may  be  present  a  retained  corpus  luteum  which  is  interfer- 
ing with  the  normal  functions  of  the  uterus.  In  such  cases 
the  corpus  luteum  should  be  dislodged.  If  the  estrual  cycle 
is  normal  and  the  estrum  is  apparently  normal,  the  corpus 
luteum  should  not  be  disturbed. 

B.   Pyometra 

Pyometra  occurs  in  heifers  which  are  not  known  to  have 
conceived.    There  are  several  types : 

(1)  There  occurs  from  time  to  time  an  arrest  in  the  de- 
velopment of  the  ducts  of  Mueller,  to  which  allusion  has 
been  made  in  Chapter  IV,  by  which  the  cervical  canal  or 
the  canal  of  the  uterus  or  one  of  the  horns  does  not  become 
excavated,  and  consequently  there  occurs  an  accumulation 
of  menstrual  debris,  which  sometimes  becomes  infected  and 
takes  on  the  general  character  of  an  abscess  of  the  uterine 
horn.  Presumably  the  infection  is  lodged  within  the  cavity 
of  the  horn  or  uterus  during  fetal  life  or  in  early  calfhood 
and  has  finally  become  active  in  the  presence  of  large  vol- 


Uterijie  hifedions  459 

umes  of  menstrual  debris.  In  some  cases  the  infection  may 
invade  the  cystic  horn  after  puberty,  but  this  cannot  be 
definitely  determined. 

Clinically  the  condition  is  recognized  by  rectal  palpation. 
Ordinarily  attention  is  drawn  to  the  genital  tract  by  steril- 
ity. Sometimes,  when  the  occluded  horn  becomes  greatly 
distended,  it  inhibits  estrum ;  sometimes  estrum  occurs,  but 
conception  fails  and  an  examination  is  made.  I  have  not 
observed  pregnancy  in  the  anatomically  sound  horn  when 
the  other  horn  is  cystic  and  occluded  at  its  base.  It  is  not 
quite  clear  why  this  should  be  so  if  the  one  horn  is  normal. 
Upon  rectal  palpation  the  examiner  finds  one  horn  normal 
while  the  other  horn  has  a  narrow  hard  area  at  its  base  and 
the  apex  may  be  distended  very  greatly  with  fluid.  Those 
which  I  have  seen  have  contained  from  8  to  25  or  30  ounces 
and  are  very  tense.  It  is  difficult  in  some  cases  to  get  a 
clear  tracing  of  the  condition,  because  the  cystic  horn  bulges 
out  over  the  normal  one  and  covers  its  own  base,  rendering 
accurate  palpation  very  difficult.  Therefore  it  requires  pa- 
tience to  reach  a  proper  diagnosis.  The  ovaries  are  usually 
normal. 

The  actual  condition  varies  greatly.  It  is  to  be  regarded 
fundamentally  as  an  arrest  in  the  development  in  the  ducts 
of  Mueller,  as  has  already  been  described  in  Chapter  IV  and 
illustrated  in  Fig.  164,  which  shows  a  non-infected  uterus 
with  several  transverse  septa  in  the  horns.  In  the  next 
figure,  165,  is  shown  a  typical  case  of  cystic  cornu  of  the 
type  which  occasionally  becomes  infected,  the  contents  be- 
coming purulent. 

The  prognosis  has  not  been  definitely  learned  for  cases  in 
general.  It  would  appear  that  the  removal  of  the  cystic 
horn  with  the  ovary  should  bring  about  favorable  results. 
In  one  instance  I  amputated  a  cystic  cornu  in  which  the 
cyst  contents  had  undergone  purulent  changes.  The  animal 
had  not  been  in  estrum  for  a  great  many  months.  As  soon 
as  she  recovered  from  the  operation,  estrum  returned  regu- 
larly, but  the  result  of  breeding  has  not  been  learned.  So 
far  as  I  could  see,  she  should  breed. 


460 


Diseases  of  the  Genital  Organs 


The  amputation  was  made  by  performing  laparotomy  in 
the  middle  flank  region  upon  the  corresponding  side,  as  far 
posterior  as  possible.  The  cystic  cornu  and  the  correspond- 
ing ovary  were  removed.  Recovery  from  the  operation  was 
prompt  and  uneventful.  This  is  probably  the  only  effective 
way  to  handle  the  malady. 


Fig.  165— Atresia  of  Uterine  Horn  at  Base,  with  Cystic  Distension. 
Vagina,  cervix,  and    left  uterine  horn   laid   open.     Top  of  right  cystic  horn 

laid  open,  showing  the  floor  of  the  cyst.     Viewed  from  right  .side 

/,   Cervix  ;    2,  left  horn  laid  open  ;    j,  cystic  base  of  right  horn  at  point  of 

atresia  ;  4,  apex  of  cystic  right  horn,  partly  separated  from  ,•■  by 

a  transverse  septum  ;  5,  corpus  luteuni  in  right  ovary. 

(2)  Pyometra  also  occurs  in  the  heifer  because  of  imper- 
forate hymen.  I  have  seen  a  two-year-old  heifer  suffering 
greatly  from  genital  trouble  which  was  causing  severe 
straining.  There  was  marked  emaciation  and  general  ill 
health.  During  the  severe  expulsive  efforts  a  portion  of 
the  genital  system  protruded  between  the  lips  of  the  vulva. 
Upon  clinical  examination  it  was  found  that  the  vulva  was 


Uterine  Infections  4^  i 

open  and  normally  developed  but  the  vagina  could  not  be 
entered,  as  the  hymen  was  very  thick  and  imperforate. 
Upon  rectal  examination  the  vagina  vv^as  found  to  be  greatly 
distended  with  pus.  The  distension  of  the  genital  tube  in- 
volved the  uterine  cavity  as  well.  The  hymen  was  incised, 
and  about  a  gallon  of  highly  fetid  thin  pus  escaped.  Re- 
covery was  slow.  The  ultimate  result  oi  the  operation,  so 
far  as  breeding  is  concerned,  is  unknown  to  me,  but  it  is 
highly  improbable  that  she  will  breed.  The  probabilities  are 
that,  under  the  great  mechanical  pressure  of  the  contents, 
the  pus  was  forced  into  the  oviduct  to  cause  pyosalpinx. 
Had  the  condition  been  recognized  early  and  relief  given, 
the  prognosis  should  presumably  have  been  good. 

(3)  Other  isolated  cases  of  pyometra  occur  in  heifers 
the  precise  nature  of  which  cannot  be  readily  determined. 
In  one  instance,  when  I  was  called  in  consultation  with  a 
colleague,  a  valuable  heifer  was  found  to  have  voluminous 
pyometra  with  complete  paralysis  of  the  uterus  and  passive 
retention  of  the  pus.  The  uterus  had  dropped  far  forward 
into  the  abdomen,  where  it  could  not  be  efficiently  palpated. 
The  cervical  canal  was  open.  There  was  no  history  of  any 
discharge  from  the  genital  tract.  Apparently  the  pus  lay 
passively  in  the  paretic  uterus.  The  clinical  history  of  the 
animal  was  uncertain.  She  had  been  purchased  by  the 
owner  some  months  previously  as  a  pregnant  animal.  It 
was  impossible  to  determine  whether  she  had  ever  been 
pregnant,  since  an  accurate  clinical  history  of  such  an  ani- 
mal ordinarily  ceases  to  exist  with  change  in  ownership. 

My  colleague  had  diagnosed  pregnancy  because  the  uterus 
was  enlarged  and  had  dropped  far  forward  in  the  abdomen 
and  because  there  was  no  evidence  of  pyometra  in  the  way 
of  genital  discharge.  When  it  was  attempted  to  examine 
the  uterus  by  douching  in  order  to  determine  the  character 
of  the  trouble,  a  soft  rubber  horse  catheter  was  introduced 
deeply  into  the  uterine  cavity  and  a  normal  and  physiologic 
salt  solution  introduced  into  the  uterus  by  gravity.  After 
two  or  three  quarts  had  been  introduced,  the  introduction 
was  suspended  and  an  effort  made  to  siphon  out  the  con- 


462  Diseases  0/  the  Genital  Organs 

tents,  but  when  the  distal  end  of  the  catheter  was  lowered 
no  fluid  was  obtained.  I  began  to  wonder  why  it  should 
behave  in  this  way.  More  fluid  was  then  introduced  into 
the  uterus  and,  while  it  was  still  flowing  in,  the  distal  end 
of  the  catheter  was  compressed,  lowered,  and  then  released. 
Pus  commenced  to  siphon  out  and  the  uterus  was  relieved 
of  three  to  four  gallons.  I  have  had  similar  experience  in 
cows  where  the  same  error  has  been  made  with  the  siphon 
and  the  veterinarian  led  to  believe  that  no  pus  or  other 
pathologic  contents  is  present.  The  difficulty  is  that,  when 
the  fluid  is  being  introduced  by  gravity,  if  the  veterinarian 
is  not  cautions,  it  all  passes  at  once  into  the  paretic  uterine 
cavity,  exhausting  the  column  of  fluid  in  the  catheter  essen- 
tial to  the  process  of  siphoning. 

The  prognosis  of  this  rather  rare  condition  is  highly  un- 
favorable. I  have  not  had  an  opportunity  for  post-mortem 
examination,  but  suspect  that  it  originates  as  hydrometra 
(which  see)  and  later  the  fluid  becomes  infected  and  puru- 
lent, the  uterus  remaining  absolutely  paretic.  The  uterine 
mucosa  is  probably  completely  destroyed,  and  hence  the 
animal  is  absolutely  sterile.  If  one  has  reason  to  believe 
otherwise,  the  only  treatment  which  can  be  suggested  at 
present  is  to  siphon  out  the  contents  frequently,  douche  the 
cavity  well  with  disinfectants,  such  as  2  per  cent.  Lugol's 
solution,  which  must  be  carefully  removed,  and  then  intro- 
duce slow-dissolving  disinfectants,  such  as  iodoform  and 
bismuth,  in  the  hope  that  the  diseased  condition  may  in  this 
way  be  overcome. 

2.    The  Infections  of  the  Gravid  Uterus 

A.  Apical  Endometritis  with  Necrosis  of  the 
Apices  of  the  Fetal  Sac 

When  considering  the  development  of  the  fetal  membranes 
in  Chapter  I,  it  was  noted  that  the  tips  of  the  fetal  sacs  of 
ruminants  and  swine  regularly  become  necrotic,  as  shown  in 
Figs.  34,  35.  This  is  regarded  as  normal  by  some  embryolo- 
gists,  but  careful  study  in  the  abattoir  denies  this  assump- 
tion.    The  necrotic  tip   is   regularly  of  a  dirty  yellowish- 


hifedions  of  the  Gravid  Uterus  463 

brown  color  and  frequently  desiccated.  It  varies  in  extent 
from  one-fourth  inch  or  less  to  eight  or  ten  inches.  The 
necrosed  part  lies  free  within  the  horn,  surrounded  by  a 
dirty  yellowish  or  yellowish  brown  flocculent  exudate,  some- 
times watery,  sometimes  of  pap-like  consistency.  Some- 
times the  necrotic  tip  is  flat,  crumpled  and  desiccated ;  some- 
times it  is  soft  and  pliable,  and  its  lumen  persists  in  continu- 
ity with  the  allantoic  sac.  Rarely  the  amniotic  tips  partici- 
pate in  the  necrosis  and  become  adherent  in  the  necrotic 
allantoic  area.  The  extremities  of  the  amnion  thus  become 
fixed  in  the  apices  of  the  allantois,  the  amnion  is  incapable 
of  contracting  about  the  embryo,  the  tension  upon  the  am- 
nion at  its  attachment  to  the  ventral  floor  of  the  embryo  be- 
comes too  great,  the  embryo  everts,  and  schistocormus  re- 
flexus  follows. 

Associated  with  such  necrosis  of  the  membranes,  there 
exists  as  a  rule  a  macroscopically  recognizable  endometritis 
of  the  contiguous  uterine  mucosa.  The  mucosa,  definitely 
thickened  and  edematous,  generally  bears  upon  the  surface 
dirty  yellowish  or  reddish  sediment,  resembhng  brick-dust 
and  closely  adherent.  There  are  wide  variations.  In  nu- 
merous cases  the  exudate  is  of  a  dirty  yellowish-brown 
color,  tenacious  and  abundant.  In  some  cases,  as  shown  in 
Colored  Plate  III,  the  exudate  fills  the  non-gravid  horn  from 
apex  to  base  and  presents  the  characters  of  "the  exudate  of 
contagious  abortion."  Between  the  extremes  named  every 
grade  of  endometritis  is  seen.  The  volume  and  type  of  en- 
dometritis correspond  with  the  necrosis  of  the  tip  of  the 
fetal  sac.  The  necrosis  of  the  tip  and  the  endometritis  are 
regularly  greatest  in  the  non-gravid  horn.  It  is  possible 
that  in  some  cases  the  pre-conceptional  infection  is  so  great 
in  one  horn  that  fertilization  on  that  side  is  blocked  and 
pregnancy  occurs  on  the  side  of  least  infection.  In  such 
case  the  lesions  would  naturally  be  most  marked  upon  the 
non-gravid  side.  I  think,  however,  that  this  hypothesis  ex- 
plains few  cases.  The  more  probable  cause  of  the  variation 
is  the  lesser  vitality  of  the  membranes  in  the  non-gravid 
horn.    They  are  far  less  vascular  and,  in  harmony  with 


464  Diseases  of  the  CeJiital  Origans 

general  rules  of  bacterial  invasion,  should  afford  less  re- 
sistance. 

The  histology  of  apical  endometritis  has  not  been  studied. 
The  bacteriology  has  had  almost  no  attention.  My  col- 
leagues, Carpenter  and  Hagan,  have  obtained  chiefly  strep- 
tococci of  the  viridans  type  and  paracolon  organisms. 

The  date  of  invasion  of  the  cornual  apices  is  apparently 
pre-conceptional.  The  infection  probably  enters  frequently 
from  the  oviducts.  Evidently  it  may  also  proceed  from  the 
cervix.  Its  significance  is  not  fully  understood.  When  as 
virulent  as  shown  in  Plate  III,  it  must  have  serious  peril 
for  the  health  of  the  embryo  and  apparently  endangers  the 
uterus  itself.  The  chief  danger  to  the  embryo  is  the  inva- 
sion of  the  fetal  fluids  through  the  necrotic  area.  Since 
the  allantoic  fluid  regularly  extends  into  the  necrotic  tips, 
its  contamination  is  unavoidable.  Once  the  infection  has 
invaded  the  allantoic  fluid,  it  may  grow  through  the  amnion 
and,  reaching  the  amniotic  fluid,  be  swallowed  by  the  em- 
bryo during  its  constant  physiologic  process  of  swallowing 
its  amniotic  fluid.  It  is  not  necessary  that  bacteria  shall 
penetrate  the  amnion  in  order  to  reach  the  amniotic  fluid. 
They  may  instead  be  borne  in  the  fluid,  through  the  urethra, 
bladder  and  urachus,  to  the  amniotic  fluid,  and  eventually 
be  swallowed. 

Apical  endometritis  of  pregnancy,  since  it  is  not  clini- 
cally diagnosable,  offers  no  field  for  therapeutic  effort.  So 
far  as  known,  its  prevention  is  dependent  upon  the  funda- 
mental principle  that  the  health  of  an  embryo  is  primarily 
dependent  upon  the  soundness  of  the  genital  organs  of  both 
parents  at  the  time  of  coitus. 

B.  Diffuse  Endometritis  of  Pregnancy.     The 
"  Dystocia  of  Contagious  Abortion  " 

There  is  observed  in  the  abattoir  an  endometritis  of  the 
pregnant  uterus  in  which  the  disease  processes  are  quite 
evenly  diffused  throughout  the  entire  uterine  cavity.  Some- 
times the  endometrium  is  swollen  and  edematous  and  its 
vessels  are  visibly  engorged.     A  yellowish,  yellowish-brown, 


Infections  of  the  Gravid  Uterus  465 

or  greenish-brown  exudate  of  an  extremely  viscid,  sticky 
character  covers  the  non-placental  portions  of  the  uterine 
mucosa  and  the  chorion.  The  fetus  may  be  apparently 
healthy.  In  other  instances  the  fetus  shows  evidences  of 
having  long  been  dead.  The  fetal  and  maternal  placentae 
have  separated  and  the  fetal  membranes  are  necrotic,  soft, 
and  non-resistant.  The  fetus  is  soft  and  only  faintly  odor- 
ous. The  uterus  is  edematous,  flaccid,  and  paretic.  The 
utero-chorionic  space  is  occupied  by  dirty,  grayish,  floccu- 
lent  exudate.  There  is  little  evidence  of  any  tendency  to 
expel  the  fetus. 

Clinical  observations  appear  parallel  to  those  of  the  abat- 
toir. In  my  companion  volume'  I  have  held  that  most  dys- 
tocia in  cows  is  due  to  a  uterine  atony  dependent  upon  intra- 
uterine infection  in  which  the  fetus  participates.  Whether 
the  fetus  be  alive  or  dead,  the  uterus  contracts  feebly,  caus- 
ing tardy  dilation  of  the  cervical  canal  and  delayed  expul- 
sion of  the  fetus.  Preceding,  accompanying,  or  following 
the  expulsion  of  the  fetus,  an  exudate  in  varying  amounts 
is  expelled  by  the  uterus.  The  fetus  may  perish,  to  undergo 
later  maceration  or  emphysema.  This  type  of  metritis  of 
pregnancy  is  usually  not  diagnosed  clinically  until  its  pres- 
ence is  revealed  by  the  advent  of  dystocia.  Its  handling 
then  logically  falls  within  obstetrics,  where  it  has  already 
been  considered.  After  the  dystocia  has  been  overcome,  the 
metritis  is  to  be  handled  as  advised  under  "Diseases  of  the 
Puerperal  Uterus." 

C.  Cervical  Endometritis 

Cervical  endometritis,  which  constitutes  the  essential 
basis  in  the  phenomenon  of  abortion,  is  the  primary  lesion 
which  finally  arouses  contractions  of  the  ovarian  end  of  the 
uterus  with  the  expulsion  of  the  uterine  contents.  Less 
frequent  than  apical  endometritis,  it  plays  a  larger  role  in 
interfering  with  reproduction.  Cervical  endometritis  con- 
sists of  an  ascending  or  centripetal  infection  advancing 
from  the  cervical  toward  the  ovarian  end  of  the  uterus.    In 

*  Veterinar}-  Obstetrics,  19 17.  3" 


466  Diseases  of  the  Genital  Organs 

many,  probably  in  most  cases,  cervical  endometritis  is  the 
result  of  an  extension  of  infection  from  the  cervical  mucosa 
forward.  In  the  most  outstanding  cases,  the  infection  evi- 
dently extends  from  the  cervical  canal,  as  illustrated  in  Fig. 
174,  in  which  the  cervical  seal  has  failed  to  form  and  a  me- 
tritis has  served  to  destroy  the  placental  relations  about  the 
OS  uteri  internum,  so  that  portions  of  the  chorion,  some  of 
which  are  necrotic,  protrude  through  the  cervical  canal  into 
the  vagina.  At  the  same  time  the  embiTO  may  be  living 
and  not  visibly  involved,  but  ultimately  the  fetus  must  par- 
ticipate in  the  infection  and  abortion  follow. 

Cervical  endometritis  is  not  always  clinically  recognizable, 
but  in  many  cases  it  is  very  evident.  Frequently  the  uterine 
seal  is  imperfect,  is  wanting  in  resistance  or  density,  or 
may  be  discolored.  In  some  cases,  like  Fig.  174,  portions  of 
the  fetal  sac  protrude  into  the  vagina.  The  protruding 
parts  are  usually  necrotic,  but  moderate  traction  ordinarily 
brings  living  vascular  membranes  into  view.  Such  cases 
are  well  advanced  on  the  road  to  abortion. 

Cervical  endometritis  is  sometimes  diagnosable  by  means 
of  rectal  palpation,  owing  to  the  atony  of  the  pregnant 
uterus.  Physiologically  the  gravid  uterus  is  tonic  to  the 
sense  of  touch,  but  in  some  cases  of  disease  the  organ  is 
clearly  atonic,  soft,  paretic,  and  flabby. 

So  far  as  known,  the  infection  of  cervical  endometritis 
exists  within  the  cervical  end  of  the  uterus  or  in  the  contin- 
uous cervical  canal  at  the  time  of  conception.  The  infection 
may  exist  at  the  time  of  coitus  or  may  be  transmitted  by 
coitus  as  a  seminal  contamination. 

In  studying  the  bacteriology  of  cervical  endometritis, 
most  investigators  have  searched  for  the  B.  abort )(s  only, 
and  when  they  have  not  recovered  that  organism  have  re- 
ported the  findings  as  negative.  A  few  investigators  have 
reported  the  finding  of  paracolon  or  paratyphus  bacilli.  B. 
pyogenes,  streptococci,  etc.  The  B.  abortus,  according  to 
recorded  observations,  is  frequently  present  and  apparently 
plays  an  important  part  in  the  metritis,  but  just  what  part 
is  not  precisely  known,  because  the  other  organisms  present 


hifecfions  of  the  Gravid   Uterus  467 

have  not  been  studied  in  connection  with  it.  The  researches 
of  my  colleagues,  Carpenter  and  Hagan,  have  thus  far  indi- 
cated that  in  the  cases  investigated  by  them  the  B.  abortus 
is  not  the  dominant  organism. 

The  prognosis  of  cervical  endometritis  is  unfavorable. 
The  fetus,  which  inevitably  participates  in  the  invasion, 
may  perish  and  be  expelled,  may  be  born  highly  infected,  or 
with  large  numbers  of  bacteria  included  within  the  meco- 
nium and  later  break  down  with  septicaemia,  dysentery, 
pneumonia,  or  pyaemia.  In  the  cow  the  metritis  inevitably 
persists  into  the  puerperal  period  or  beyond,  frequently 
complicated  with  retained  placenta.  Cervical  endometritis 
is  not  amenable  generally  to  handling  during  pregnancy. 
When  clearly  recognized,  in  such  cases  as  that  illustrated  in 
Fig.  174,  where  abortion  is  clearly  foretold,  the  emptying 
of  the  diseased  uterus  should  be  the  first  aim.  I  have  prac- 
ticed, and  recommend,  douching  the  uterus  with  a  weak 
antiseptic  solution,  such  as  0.5  per  cent.  Lugol's  solution, 
through  the  open  cervical  canal.  This  tends  to  detach  the 
fetal  sac  from  the  maternal  placentules  and  to  cause  the 
prompt  expulsion  of  embryo  and  embrj^onic  sac.  Once  the 
uterus  is  empty,  the  diseased  uterus  may  be  handled  and  re- 
stored to  health.  The  prevention  of  the  cervical  endometri- 
tis of  pregnancy  is  fundamentally  dependent  upon  the  mat- 
ing of  two  animals  with  clean  sexual  organs. 

D.  Septic  Metritis  of  Pregnancy  with  Uterine  Gangrene 
Septic  metritis  of  the  pregnant  uterus  with  uterine  gan- 
grene is  not  rare.  It  bears  a  close  relationship  to  the  dif- 
fuse endometritis  of  pregnancy  and  represents  a  more  viru- 
lent course  of  infection.  As  a  rule,  the  existence  of  intra- 
uterine infection  passes  unnoted  clinically  until  suddenly  the 
disease  breaks  out  in  a  storm  and  its  presence  becomes  evi- 
dent. Usually  it  appears  at  or  near  the  close  of  the  physio- 
logic duration  of  pregnancy,  showing  itself  in  two  types. 

Most  commonly  the  animal  unexpectedly  becomes  dull. 
There  may  be  some  atonic  expulsive  efforts.  Usually  the 
cervix  relaxes  and  necrotic  fetal  membranes  protrude  from 


468  Diseases  of  the  Geiiital  Organs 

the  vulva.  Uterine  paresis  ensues  so  quickly  that  there  can 
be  no  uterine  contractions.  Should  expulsive  efforts  be 
present,  they  are  confined  to  the  contractions  of  the  abdomi- 
nal walls.  The  efforts  are  feeble  and  futile.  If  the  fetal 
cadaver  is  removed,  the  membranes  with  the  uterine  cotyle- 
dons, which  are  necrotic,  come  away  together.  The  uterine 
walls  are  hard  and  thick.  Involution  fails;  instead,  the 
uterus  collapses  in  response  to  compression  by  the  surround- 
ing viscera.  The  uterine  cavity  may  contain  an  indefinite 
amount  of  a  thin,  black  or  reddish-black  exudate  which  ap- 
pears to  consist  chiefly  of  disintegrated  red  blood  cells.  The 
exudate  is  usually  fetid. 

The  prognosis  in  this  group  is  very  unfavorable.  A  com- 
paratively large  percentage  of  cows  survive,  but  very  few 
recover.  Eventually  most  survivors  must  go  to  the  butcher 
because  of  incurable  sterility.  The  indications  for  handling 
consist  of  the  surgical  evacuation  of  the  uterus,  followed  by 
the  general  plan  for  handling  puerperal  metritis,  to  be  de- 
scribed later. 

The  other,  and  less  frequent  group  of  gangrenous  metri- 
tis of  pregnancy  presents  the  cardinal  symptoms  of  the  gan- 
grenous metritis  of  the  puerperal  period,  except  for  the 
presence  of  the  fetal  cadaver  with  non-dilation  or  imperfect 
dilation  of  the  cervical  canal.  The  patient  is  apparently 
well  and  in  good  condition,  until  suddenly  she  appears  to  be 
critically  ill.  The  general  appearance  is  one  of  great  de- 
pression bordering  upon  collapse.  The  pulse  is  rapid  and 
very  weak.  The  respiration  is  quickened  and  shallow.  The 
temperature  is  erratic  and  is  frequently  subnormal.  The 
eyes  are  sunken  and  the  cornea  appears  dry  and  opaque. 
Tears  mixed  with  muco-pus  flow  down  over  the  cheeks  and 
face.  There  is  a  copious  discharge  of  mucus  from  the  nos- 
trils and  of  saliva  from  the  mouth.  Severe  diarrhea  is  usu- 
ally present,  the  feces  being  watery,  dirty  black,  and  very 
fetid.  The  animal  moves  only  under  compulsion,  and  then 
totters.  In  some  cases  the  cow  or  heifer  is  found  down  and 
unable  to  rise  only  fifteen  or  twenty  hours  after  she  ap- 
peared well.    Sometimes  necrotic  fetal  membranes  protrude 


Infections  of  the  Gravid  Uterus  469 

from  the  vulva.  In  other  cases  vaginal  examination  reveals 
necrotic  membranes  protruding  from  the  cervical  canal. 
Sometimes  the  cervical  canal  is  dilated  little  or  none  at  all, 
but  may  be  open,  and  the  examiner  may  find  that  the  uterine 
seal  is  absent  or  breaking  down  and  mixed  with  thin,  black, 
fetid  exudate.  The  cervix  is  comparatively  sound;  the 
uterus,  wholly  necrotic,  is  powerless  to  dilate  the  cervix. 
Rectal  palpation  generally  reveals  an  enormously  enlarged, 
emphysematous  fetus  which  crepitates  under  manipulation. 
The  massive  fetal  cadaver  may  be  palpable  from  the  exterior 
through  both  flanks. 

The  prognosis  is  hopeless.  The  animal  dies  within  twelve 
to  forty-eight  hours, 

E.  The  Placentitis  of  Pregnancy 

Endometritis  can  not  readily  occur  without  participation 
of  both  the  placental  and  non-placental  areas.  Generally 
the  non-placental  areas  suffer  primarily  while  the  placental 
structures  show  an  interesting  degree  of  resistance.  So 
there  is  observed  an  intercotyledonal  endometritis  with 
great  volumes  of  exudate  in  the  utero-chorionic  space,  while 
the  placental  structures  are  apparently  intact  and  the  fetus 
is  alive  and  healthy.  But  it  is  difficult  to  understand  how 
an  important  infection  can  exist  for  a  long  period,  when  of 
large  volume  or  high  virulence,  without  involving  also  the 
placental  structures.  It  appears  certain  that  as  a  rule  the 
placental  areas  are  the  most  resistant  of  the  uterine  mucosa, 
and,  so  far  as  investigators  have  proceeded,  this  view  is  well 
supported.  In  studying  the  pregnant  uterus  in  the  abattoir, 
interesting  lesions  are  recognizable  which  serve  to  explain, 
or  to  add  interest  to,  some  clinical  phenomena. 

(a)  Peripheral  placentitis.  As  a  rule  some,  many,  or  all 
placentules  in  the  gravid  uterus  show  peripheral  dehiscence. 
The  chorionic  tufts  have  become  detached  and  lie  outside 
the  placental  crypts.  The  separation  is  usually  apparent 
after  the  sixth  month  of  pregnancy  and  becomes  increas- 
ingly prominent  as  pregnancy  nears  its  close.  Some  of  the 
smaller  placental  areas  about  the  os  uteri  internum  become 


470 


Diseases  of  the  Genital  Organs 


wholly  detached,  but  further  forward  the  larger  cotyledons 
show  merely  a  very  few  peripheral  chorionic  tufts  displaced 
from  the  placental  crypts.  The  displaced  tufts  are  white  or 
grayish-white,  due  apparently  to  anemia  owing  to  the  inter- 
ruption of  the  physiologic  placental  contact.  The  phenome- 
non is  so  nearly  universal  that,  like  the  necrotic  tip  of  the 
fetal  sac,  it  may  be  designated  normal  in  the  sense  that  is  is 
generally  present.    Its  significance  is  unknown. 

(b)  Inter-placental  hemorrhage  with  fetal  desiccation  is 
a  more  interesting  and  at  present  more  important  clinical 
manifestation  of  placental  disease.     It  has  not  been  shown 


Fig.  i66— Inter-Placental  Hemorrhage  with  Desiccation  of  Fetus,  in  Early  Stages. 

/,  ''Cervical   canal  ;    //,   lienialonia   fiUiiij^    uterus  and    covL-rinj^    fetal    sac  ;     C,   chorion    incised 

and  turned  1)ack  ;  /*',  fetus  ;   CA,  corpus  luteuni. 


to  be  dependent  upon  disease  of  the  non-placental  uterine 
areas. 

In  the  abattoir  I  have  observed  marked  inter-placental 
hemorrhage  involving  uniformly  all  cotyledons.  In  one  well 
marked  case  none  of  the  blood  had  escaped  into  the  utero- 
chorionic  space,  the  peripheral  tufts  having  maintained  their 
contact.  In  a  manner  this  is  a  reversal  of  the  peripheral 
dehiscence  described  in  the  preceding  paragraph. 

It  seems  perfectly  clear  that  this  phenomenon  is  the  ini- 
tial stage  of  desiccation  or  mummilication  of  the  fetus.     In 


InfectioJis  of  the  Gravid  Uterus  47 1 

the  second  stage  the  hemorrhage  is  greater,  the  inter-pla- 
cental  hemorrhage  forces  the  fetal  and  maternal  placentae 
apart,  and  the  blood  forces  its  way  in  great  volume  to  every 
part  of  the  uterine  cavity,  enveloping  the  fetal  sac  in  a  vast 
incapsulating  hematoma,  as  show^n  in  Fig.  166.  The  fetus 
at  once  perishes  from  asphyxia.  If  bacteria  are  present, 
they  are  non-pyogenic.  After  the  cessation  of  the  hemor- 
rhage, the  blood  serum  is  slowly  absorbed  and  the  absorption 
of  the  amniotic,  allantoic,  and  tissue  fluids  gradually  follows. 
Finally  there  remains  a  hard,  dry,  rigid,  and  distorted  dark 
brown  fetal  cadaver,  consisting  of  the  dried  skin,  bones,  and 
other  skeletal  tissues  with  a  thin  parchment-like  membrane 


Fig.   167— Inter-Placental   Hemorrhage  with  Desiccation   of  Fetus- 
The  desiccation  has  progressed  farther  than  in  Fig.  166. 

/,  Hematoma  in  non-gravid  horn  ;    2,  fetal  ribs  cut  across  ;  j,  hematoma  in 

uterine  body  and  gravid  horn  ;    ^,  cranial  bone  (parietal?)  of  fetus, 

5,  vagina  ;   CZ,  embedded  corpus  luteum  of  fetal  retention. 

over  them  representing  the  fetal  sac,  with  vestiges  of  the 
hematoma.  The  cervical  canal  remains  sealed ;  the  corpus 
luteum  of  pregnancy  sinks  into  the  center  of  the  ovary  (em- 
bedded corpus  luteum)  there  to  remain  indefinitely,  usually 
as  a  permanent  inhibitory  force  preventing  the  expulsion  of 
the  desiccated  cadaver,  and  inhibiting  ovulation  and  estrum. 
This  is  observed  mostly  in  heifers. 

Since  the  animal  has  been  bred  and  estrum  does  not  recur, 
pregnancy  is  assumed.  If  the  hemorrhage  occurs  late  in 
pregnancy,  the  patient  shows  the  abdominal  enlargement  of 
pregnancy  and  the  fetus  may  be  recognizable  by  ballotte- 


472 


Diseases  of  the  Genital  Organs 


ment.  If  a  heifer,  her  udder  enlarges,  verifying  the  assump- 
tion of  pregnancy.  Then  comes  a  recession  in  the  evidences 
of  approaching  parturition.  The  abdominal  enlargement  re- 
cedes imperceptibly  for  week  after  week,  the  enlarged  udder 
slowly  resumes  its  pre-conceptional  volume  and  appearance, 
and  the  time  for  parturition  draws  near  and  passes  by  with- 
out trace  of  sexual  function  of  any  kind.  The  general  health 
is  unaffected. 

Vaginal  exploration  reveals  a  typical  uterine  seal  of  preg- 
nancy. Rectal  palpation,  if  by  chance  made  soon  after  the 
occurrence  of  the  hemorrhage,  reveals  the  uterus  filled  with 
a  rather  firm,  doughy,  even  mass,  deeply  embedded  within 
which  a  fetal  cadaver  (or  sometimes  twins)  may  be  recog- 
nized.   As  desiccation  proceeds,  every  stage  is  encountered 


Fig.  i68— Complete  Desiccation  of  Fetus  following- Inter- 
Placental  Henaorrhage. 

up  to  the  completion  of  the  process,  shown  in  Y'lg.  168.  Then 
one  may  palpate  per  rectum  the  limbs,  ribs,  head,  hollow 
orbits,  and  all  skeletal  details.  The  completion  of  the  desic- 
cation will  naturally  vary.  In  a  fetus  twenty-four  inches 
long  from  nose  to  base  of  tail,  I  think  the  completion  of  the 
process  requires  six  to  eight  months. 

Bang  has  procured  cultures  of  the  B.  abortus  from  the 
desiccated  debris.  He  does  not  state  that  other  bacteria 
were  or  were  not  present.  I  am  not  aware  of  other  bacterial 
search. 


Infections  of  the  Gravid  Uterus  473 

The  prognosis  is  fair  under  surgical  interference,  but 
highly  unfavorable  when  left  to  natural  resources. 

The  removal  of  the  fetal  cadaver  by  mechanical  interven- 
tion is  unjustifiable  and  highly  dangerous.  Any  attempt  to 
dilate  the  cervix  mechanically  and  to  extract  the  rigid,  an- 
gular cadaver  is  very  difficult  and  full  of  peril.  Pituitary 
extract  has  not  been  tried,  so  far  as  I  have  seen  recorded. 
In  large  doses,  should  it  cause  uterine  contractions  of  a  se- 
vere type,  it  would  be  highly  dangerous.  Dislodgment  of 
the  corpus  luteum  has  promptly  and  uniformly  caused  the 
expulsion  of  the  cadaver  in  from  five  to  twelve  days.  The 
action  is  very  gradual  and  unaccompanied  by  any  visible 
danger.  In  most  cases  the  ovary  can  be  drawn  back  over 
the  vagina  and  the  corpus  luteum  dislodged  by  compression 
through  the  vaginal  walls.  When  fetal  death  occurs  late,  the 
ovary  may  be  dragged  too  far  forward  for  the  vaginal  meth- 
od. Removal  must  then  be  attempted  very  cautiously  per 
rectum.  It  is  to  be  remembered  that  in  long-standing  cases 
the  yellow  body  is  deeply  embedded  and  requires  firm  com- 
pression for  its  dislodgment.  Since  the  resistance  of  the 
rectal  walls  is  low,  the  operator  must  exercise  great  care  in 
order  to  avoid  rupture.  Using  care,  I  have  succeeded  in  each 
case  without  injury  to  the  rectum. 

If  the  dislodgment  of  the  corpus  luteum  can  not  be  accom- 
plished safely  by  rectal  manipulation,  laparotomy  should  be 
performed  upon  the  involved  side  and  the  ovary  directly 
compressed.  Care  should  be  taken  to  dislodge  all  lutein  tis- 
sue, since  any  remnant  may  continue  to  inhibit  estrum  and 
serve  as  a  foundation  for  the  formation  of  a  new  corpus  lu- 
teum, which  may  necessitate  a  second  operation. 

After  the  cadaver  has  been  expelled,  the  uterus  should  be 
closely  watched  and  any  remedial  measures  applied  which 
may  be  indicated  by  the  conditions  present.  The  expulsion 
of  the  desiccated  fetal  cadaver  inevitably  causes  contusions 
and  abrasions  of  uterus,  cervix,  vagina,  and  vulva.  The 
most  prudent  action  which  can  be  suggested  at  present  is 
to  introduce  into  the  uterine  cavity  four  to  eight  ounces  of 
white  mineral  oil  or  liquid  paraffin,  to  which  has  been  added 


474  Diseases  of  the  Genital  Organs 

one-half  ounce  each  of  iodoform  and  bismuth  subnitrate. 
This  serves  to  soften  and  to  disinfect  any  debris  left  in  the 
uterine  cavity,  and  finally  to  cause  its  expulsion. 

The  prognosis  is  uncertain.  I  have  been  unable  to  follow 
my  cases  properly  and  have  not  known  accurately  the  re- 
sults.   They  should  largely  recover  their  breeding  power. 

(c)  Incarceratirig  placentitis  of  pregnancy  constitutes 
the  essential  basis  of  retained  fetal  membranes  during  the 
puerperal  period.  It  is  unrecognizable  during  pregnancy 
and  is  first  revealed  when  parturition  or  abortion  has  oc- 
curred. Its  intensity  and  degree  of  development  during 
pregnancy  largely  determines  the  intensity  and  duration  of 
the  retention  of  the  fetal  membranes  after  calving  or  abort- 
ing. Like  cervical  endometritis,  it  regularly  has  its  incep- 
tion at  the  cervical  end  of  the  uterus  and  radiates  toward 
the  ovarian  extremity.  In  abortion  occurring  the  first  few 
months  of  pregnancy  the  course  of  the  placentitis  and  the 
detachment  of  the  membranes  are  completed  early  and  the 
embryo  is  expelled  surrounded  by  its  membranes.  Exten- 
sive placentitis  (cotyledonitis)  during  pregnancy  is  incom- 
patible with  birth,  because  the  disease  causes  fetal  death. 
The  tendency,  therefore,  is  for  the  duration  of  the  placen- 
titis of  pregnancy  and  that  of  the  puerperal  period  to  be  in- 
verted— the  longer  the  placentitis  has  existed  during  preg- 
nancy, the  shorter  its  course  after  calving  or  aborting.  This 
rule  is  greatly  disturbed,  however,  by  the  termination  of 
pregnancy.  The  birth  or  abortion,  by  causing  extreme  dila- 
tion of  the  cervical  canal,  vagina,  and  vulva,  opens  the  way 
for  fresh  infection  from  without,  and  causes  vital  changes 
in  the  supply  of  oxygen  to  the  uterine  cavity,  with  modifica- 
tions of  bacterial  activity.  The  contusions  and  abrasions 
incident  to  the  expulsion  of  the  fetus  increase  the  opportu- 
nity for  bacterial  multiplication. 

(d)  Necrosis  of  the  cotiiledoiis  at  the  cervical  end  of  the 
uterus  occurs  but  rarely  during  pregnancy,  and  then  only 
to  a  limited  extent,  without  seriously  imperilling  the  life  of 
the  fetus.  In  the  non-gravid  horn,  however,  all  the  cotyle- 
dons may  become  necrotic,  as  shown  in  Colored  Plate  III. 


C       JJ 


Q  = 

ii 

o  S 

U  g 

fa  o 

o  ^ 

z  c 

o  (^ 

S  < 
o   ^ 

fc,  < 

c  _- 


P-S 


.0  ^ 


Infections  of  the  Gravid  Uterus  475 

without  notable  injury  to  the  fetus.  This  is  analogous  to 
the  observations  upon  swine  embryos,  in  which  extensive 
necrosis  commonly  occurs  at  both  ends  of  the  embryonic 
sacs  without  invading  the  essential  placental  structures.  In 
this  manner  the  peril  to  the  embryo  is  limited  chiefly  to  the 
passage  of  bacteria  through  the  necrotic  area,  while  the 
placenta  continues  to  function  physiologically.  Rarely,  the 
placentitis  of  pregnancy  is  of  such  virulence  that  all  cotyle- 
dons become  necrotic  simultaneously  or  in  rapid  succession. 
The  fetus  then  perishes,  the  uterine  walls  are  paretic,  and, 
if  the  mother  survives,  the  embryo  macerates  or  the  uterus 
undergoes  abscessation. 

(e)  Adventitious  placental  structures  regularly  follow 
the  necrosis  of  the  cotyledons,  whether  it  occurs  during  or 
after  pregnancy.  Adventitious  placentae  are  not  seen  in 
heifers,  but  are  common  in  cows,  where  they  serve  as  proof 
of  the  prior  necrotic  destruction  of  cotyledons.  In  the 
uterus  of  the  pregnant  heifer,  placental  contact  is  regularly 
limited  to  the  distinctive  cotyledonal  or  placental  areas. 
With  each  succeeding  pregnancy,  there  is  an  increased 
probability  of  necrosis  of  some  of  the  cotyledons  about  the 
OS  uteri  internum.  In  the  area  denuded  of  cotyledons,  ad- 
ventitious placental  structures  develop,  presenting  macro- 
scopically  the  appearance  of  the  diffuse  placenta  of  the  mare. 
When  cotyledons  are  destroyed,  there  is  no  visible  effort  at 
compensational  hypertrophy  of  the  remaining  cotyledons, 
but  the  compensation  is  effected  through  adventitious  ac- 
tivity of  the  intercotyledonal  endometrium. 

The  adventitious  placental  structures  tend  to  invade  the 
endometrium  about  the  os  uteri  internum  and  to  form  over 
the  OS  a  virtually  continuous  placental  contact,  constituting 
in  effect  a  placental  seal,  separating  the  cervical  canal  from 
the  utero-chorionic  space.  When  parturition  begins,  the 
adventitious  placental  structures  must  give  w^ay  before  the 
cervical  canal  can  dilate  and  the  parturient  rent  occur  in 
the  chorion.  The  adventitious  placental  structures  ordi- 
narily radiate  from  the  os  uteri  internum  for  only  four  to 
ten  inches,  though  occasionally  they  involve  the  entire  uter- 


476  Diseases  of  the  Genital  Orgaiis 

ine  body  cavity  and  may  extend  deeply  into  one  horn.  In 
one  abattoir  cow  I  observed  a  complete  adventitious  (dif- 
fuse) placenta  involving  the  entire  endometrium.  While 
adventitious  placentae  are  alw^ays  the  consequence  of  coty- 
ledonal  necrosis,  extensive  death  of  the  cotyledons  is  not  or- 
dinarily followed  by  adventitious  placenta;  instead,  the  ex- 
tensive disease  commonly  includes  the  endometrium  and 
either  kills  the  patient  or  renders  her  absolutely  sterile. 

(f)  Calcification  of  the  'placenta  occurs  very  rarely.  I 
have  observed  but  one  case,  that  being  in  an  abattoir  ani- 
mal. The  calcification,  which  was  very  marked,  involved 
uniformly  all  cotyledons.  The  placental  stratum  was  pale 
yellow,  resistant  and  gritty.  There  was  no  evidence  that 
the  calcification  had  interfered  with  embryonic  development. 
The  cause  was  not  clear.  It  was  possibly  the  result  of  inter- 
placental  hemorrhage  stopping  short  of  placental  dehiscence 
and  embryonic  death.  Had  parturition  occurred,  retained 
fetal  membranes  with  necrosis  of  the  cotyledons  would 
probably  have  followed. 

(g)  Specific  placentitis,  due  to  placental  tuberculosis  and 
actinomycosis,  doubtless  occurs  rarely  and,  when  pregnancy 
terminates,  leaves  behind  an  obstinate  retention  of  the  fetal 
membranes,  the  character  of  which  is  not  clinically  appar- 
ent. Naturally  the  specific  disease  promptly  leads  to  in- 
curable sterility. 

3.    Infections  of  the  Ovum,  Embryo,  and  Fetus 

A.  Death  of  the  Fertilized  Ovum 
The  death  of  the  fertilized  ovum  is  not  directly  recog- 
nizable clinically,  but  its  occurrence  must  be  admitted. 
Ovarian  infection  evidently  causes  death  of  the  ovum  within 
the  ovisac.  When  an  ovum  passes  from  the  ovisac  into  a 
virulently  infected  oviduct,  the  cell  is  immediately  placed  in 
great  peril  and  may  perish  prior  to  fertilization.  Examina- 
tion of  infected  oviducts  after  slaughter  of  the  patient  shows 
that  the  highly  motile  spermatozoa  move  through  the  badly 
infected  tube  and  reach  the  pavilion  ready  to  fertilize  the 
ovum  as  soon  as  it  is  discharged.     Presumably  this  occurs 


Infections  of  the  Ovum,  Embryo  and  Fetus  477 

often,  but  the  newly  fertilized  ^m  has  little,  if  any,  more 
power  of  resistance  than  the  spermatozoon  and  unfertilized 
ovum  each  possessed  prior  to  their  union.  It  is  an  indisput- 
able clinical  fact  that  salpingitis  generally  prevents  recog- 
nizable pregnancy.  This  renders  it  reasonably  clear  that 
the  infection  in  the  oviducts  or  uterus  kills  the  spermato- 
zoon or  ovum.  The  recognizable  destruction  of  the  embryo 
or  fetus  is  so  common  that  the  unseen  death  of  its  earliest 
stages  must  also  be  frequent.  Any  infection  capable  of 
causing  the  death  of  an  embryo  or  fetus  must  logically  be 
more  readily  able  to  cause  death  of  the  far  less  resistant 
organism.  Thus  a  heifer  is  bred  possibly  eight  to  ten  or 
more  times  at  regular  or  irregular  intervals.  Sometimes 
she  may  appear  pregnant  for  one  to  two  or  more  months. 
Finally  she  recognizably  conceives  and  pregnancy  contin- 
ues one  hundred  to  two  hundred  or  more  days,  when  she  is 
observed  to  expel  a  fetal  cadaver.  One  death  of  a  fertilized 
Q^'g  has  been  observed,  while  many  deaths  during  the  earlier 
periods  have  passed  unseen.  The  deaths  of  the  spermatozoa 
and  of  the  unfertilized  or  fertilized  ovum  are  far  more  nu- 
merous and  cause  infinitely  greater  economic  losses  than  do 
abortions.  In  many  valuable  herds  of  pedigreed  cattle,  an 
average  of  three  copulations  is  necessary  for  each  recog- 
nizable pregnancy :  there  is  an  initial  failure  in  67  per  cent, 
of  attempts  at  reproduction. 

The  farce  of  curing  the  disease  or  preventing  the  death 
of  the  ovum,  spermatozoon,  or  fertilized  Q<g%  by  measures 
taken  after  coitus,  as  is  so  common  with  abortion,  has  not 
become  established.  The  avoidance  of  such  death  clearly 
lies  in  the  fundamental  principle  that  the  physiologic  re- 
production of  young  rests  upon  the  sexual  contact  of  two 
healthy  individuals. 

B.  Death  of  the  Embryo  with  Persistence  of  the 
Embryonic  Sac.     Cystic  Mole 
As  soon  as  the  embryo  has  formed  and  its  sac  has  ac- 
quired recognizable  dimensions,  embryonic  death  may  be 
clinically  observed  if  accurate  attention  is  given  at  the  criti- 


478  Diseases  of  the  Genital  Organs 

cal  period.  The  recognition  becomes  largely  a  question  of 
chance.  Most  embryonic  deaths  pass  unseen.  In  such  early 
deaths  the  embryonic  sac  is  by  far  the  greatest  and  most 
conspicuous  part.  Frequently  the  embryo  dies  and  all  traces 
of  it  disappear  while  its  sac  persists  and  apparently  con- 
tinues to  grow.  The  embryonic  sac  retains  its  usual  form, 
but  is  without  evident  placental  structure,  and  apparently 
maintains  its  growth  and  existence  by  absorption  of  liquids 
from  the  uterine  cavity.    One  of  these  is  illustrated  in  Fig. 


I'lG.  169— Cystic  Mole. 
Total  length  46  inches  ;  circumference,  7  inches.  At  the  top  of  the  gravid 
branch  of  the  fetal  sac  is  seen  a  thickened  spot,  apparently  marking  the 
former  location,  of  the  embryo.  Compare  with  colored  plate  II.  At  the 
cervical  end  of  the  uterus,  tlie  embryonic  sac  is  necrotic  and  desiccated. 
The  necrotic  tips  are  prominent.     Sac  removed  200  days  after  conception. 

169.  In  this  instance  there  remains  a  thickened  area  which 
faintly  suggests  the  prior  location  of  the  embryo.  The  cow 
was  examined  at  about  sixty  days  after  coitus  and  pro- 
nounced pregnant.  The  cervical  canal  was  sealed,  the  uterus 
enlarged  and  distended  in  a  manner  typical  of  pregnancy  of 
that  duration,  a  typical  corpus  luteum  of  pregnancy  was 
present,  and  estrum  was  absent.  The  general  signs  of  preg- 
nancy failed  to  advance  parallel  to  the  duration  of  time. 
Later  an  examination  disclosed  the  nature  of  the  condition, 
and  the  "mole"  was  removed. 


Infections  of  the  Ovnm    Embryo  and  Fetus  479 

The  cystic  mole  grows  slowly  and  soon  fails  to  maintain 
the  degree  of  distension  of  the  uterus  characteristic  of  the 
advancement  of  pregnancy.  Finally  its  growth  becomes 
halted  and  its  size  may  continue  static  for  an  indefinite 
period  unless  the  uterine  seal  is  imperfect  or  becomes  de- 
stroyed. Then  its  expulsion  follows.  The  expelled  cyst 
commonly  shows  two  unequal  parts  representing  the  gravid 
and  non-gravid  horns,  joined  by  a  narrow,  sometimes  ne- 
crotic, isthmus,  representing  the  area  contiguous  to  the  os 
uteri  internum. 


Fig.  170 — Desiccated  Mole.     Cow. 

The  embryo  had  perished  ^t  probably  thirt}-  days  or  less  ;    the  sac  later 

became  necrotic  and  desiccated.     In  douchinjj  the  nterus 

it  was  caught  in  the  fenestrum  of  the  catheter. 

More  frequently  the  cystic  mole  becomes  necrotic  quite 
early  and  undergoes  a  desiccation  similar  to  the  necrosis  of 
the  tips  of  the  embryonic  sac.  The  elongated  sac  collapses, 
dries  and  shrivels  until  it  becomes  a  flattened,  wrinkled, 
yellowish-brown  cord.  In  such  case  the  uterine  seal  is  ab- 
sent, either  having  failed  to  form  or,  if  formed,  having  been 
destroyed.    Clinically  I  have  seen  the  desiccated  sac  protrud- 


480  Diseases  of  the  Genital  Organs 

ing  from  the  cervical  canal  into  the  vagina.  In  douching  a 
uterus,  the  dry  structure  is  sometimes  drawn  into  the  fenes- 
trum  of  the  uterine  catheter,  and  when  the  instrument  is 
withdrawn  the  structure  is  pulled  out. 

In  all  cases  of  desiccated  mole  I  have  seen,  there  was 
present  a  well  marked  pyo-cervicitis  with  slight  purulent 
endometritis.  When  recognized,  the  mole  should  be  re- 
moved and  the  associated  cervicitis  and  endometritis 
handled  according  to  indications.  It  is  evidently  imprudent 
to  breed  such  an  animal  until  after  thorough  disinfection 
of  the  uterus  and  cervix. 

C.  Death  and  Maceration  of  the  Embryo  or  Fetus 
As  a  rule,  when  infection  advances  from  the  ovarian  end 
of  the  uterus  or  exists  in  the  central  area  and  causes  death 
of  the  embryo  or  fetus,  the  cadaver  is  not  expelled  because 
the  uterine  walls  are  rendered  paretic.  The  same  result  is 
attained  when  infection,  advancing  from  the  cervical  end  of 
the  uterus,  proceeds  so  rapidly  that  uterine  paresis  is  in- 
duced quickly.  The  embryo  or  fetus  then  undergoes  mace- 
ration. If  the  mother  survives,  either  the  pyometra  of  fetal 
decomposition  or  uterine  abscessation  follows. 

(a)  The  pyometra  of  emhrijoyiic  or  fetal  decomposition  is 
comparatively  common  in  cattle.  It  occurs  at  any  time 
after  pregnancy  is  clinically  recognizable,  up  to  the  com- 
pletion of  the  ordinary  duration  of  pregnancy.  When  occur- 
ring very  early,  the  pyometra  may  be  quite  limited.  There 
may  be  an  inconspicuous  purulent  discharge,  absence  of 
estrum,  and  non-interference  with  general  health.  It  is 
most  frequently  seen  in  heifers.  In  the  heifer  rectal  pal- 
pation generally  reveals  a  small  uterus,  distended  and 
rounded  by  purulent  contents.  The  uterus  is  ordinarily 
free  from  adhesions.  No  trace  of  a  fetal  cadaver  is  recog- 
nizable clinically.  Upon  post-mortem  the  uterus  is  found 
distended  with  pus  and  containing  skeletal  fragments,  such 
as  the  tiny  elongated  ossification  centers  of  the  long  bones. 
I  have  seen  these  less  than  one-half  inch  long.  In  one  case 
the  heifer  had  been  bred  about  one  year  previously  and  had 


Infection  of  the  Ovum,  Embryo  and  Feins 


48  I 


been  supposed  pregnant  until  near  the  time  for  parturition. 
The  pus  was  thick  and  fetid.  The  pyometra  had  extended 
into  the  oviducts  (pyosalpinx)  and  had  irrevocably  de- 
stroyed her  breeding  life. 

Embryonic  maceration  with  pyometra  probably  causes 
those  cases  of  extensive  pyometra  in  heifers,  to  which  allu- 
sion has  already  been  made,  and  those  in  cows  accompanied 
by  such  complete  uterine  paralysis  that  no  genital  discharge 


C.L. 


Fig.  171— Maceration  of  Fetus. 

/,  Cervical  lips  ;  2,  greatly  enlarged,  sclerotic  annular  fold  pushed  across  the  cervical  canal 

J,    vagina;   ^,  parietal  bone  of  embryo  ;    6"/,,  embedded  corpus  luteuni 

of  pyometra.     The  uterine  walls  are  sclerotic. 


is  evident.  In  these  cases,  if  the  pyometra  is  due  to  embry- 
onic maceration,  the  embryo  is  so  small  at  the  inception  of 
the  pyometra  that  its  skeletal  debris  is  not  recognizable 
clinically  during  douching. 

When  fetal  death  and  maceration  occur  later  in  preg- 
nancy, copious  discharge  of  fetid  pus  commonly  follows. 
The  fetal  debris  is  too  gross  and  angular  to  be  discharged 
with  the  pus.     The  soft  tissues  of  the  cadaver  dissolve  or 


482  Diseases  of  the  Genital  Organs 

become  suspended  to  constitute  part  of  the  pus.  The  bones 
separate  at  their  epiphyses  but  fail  to  dissolve.  I  have  ob- 
served cases  where  fetal  death  had  occurred  two  years  prior 
to  the  examination.  The  condition  of  the  fetal  bones  ap- 
peared static.  The  bones  become  closely  packed  together  in 
a  somewhat  irregular  oblong  mass  in  the  base  of  one  horn. 
The  interstices  between  the  bones  are  largely  filled  with 
thick,  desiccated,  intensely  fetid  pus. 

The  diagnosis  of  this  type  of  fetal  maceration  is  compara- 
tively simple  when  the  general  outlines  of  the  condition  are 
known,  but  is  often  quite  difficult  for  the  beginner.  There 
is  a  history  of  apparent  pregnancy  following  breeding. 
Later  the  progress  of  pregnancy  apparently  halts  and  a 
highly  fetid  purulent  genital  discharge  ensues.  Estrum  is 
absent.  The  genital  discharge  may  be  sanious,  owing  to 
pieces  of  the  jagged  fetal  bones  lacerating  the  endometrium 
and  causing  hemorrhage.  Palpation  of  the  uterus  per  rec- 
tum reveals  a  hard,  irregular  enlargement  in  one  horn  (ex- 
cept in  maceration  of  bicornual  twins).  A  careful  study  of 
the  enlargement  shows  that  the  parts  of  the  tumor  move 
upon  each  other  with  definite  crepitus.  The  cervical  canal 
is  generally  narrow,  and  the  cervix  hard.  If  a  catheter  is 
introduced  and  the  uterus  douched,  the  pus  may  be  largely 
washed  out  and  the  size  of  the  mass  rendered  slightly  more 
distinct.  The  bones  then  move  more  freely  when  palpated, 
rendering  the  diagnosis  clearer.  In  one  instance,  in  a  tu- 
berculin reactor,  the  fetal  mass  was  mistaken  for  uterine 
tuberculosis.  Uterine  tuberculosis,  however,  is  usually  sym- 
metrical. The  actual  diff"erentiation  lies  in  the  recognition 
of  the  fetal  bones.  In  another  case  the  admixture  of  blood 
with  the  pus  caused  a  diagnosis  of  uterine  tumor.  This 
error  should  have  been  avoided  by  more  careful  palpation. 
In  the  earlier  stages  fetal  maceration  and  fetal  desiccation 
may  be  confused.  In  desiccation  the  hematoma  dims  or 
completely  hides  the  outlines  of  the  fetal  cadaver;  in  early 
maceration  the  fetal  outline  remains.  In  maceration  the 
cervical  canal  is  generally  or  always  unsealed;  in  desicca- 
tion the  uterine  seal  is  ordinarily  perfect.     The  progress  of 


Infections  of  the  Ovum,  Embryo  and  Fetus  483 

desiccation  is  illustrated  in  Figs.  166-168.  An  old  uterine 
hematoma  of  puerperal  origin  may  also  lead  to  confusion  in 
diagnosis.  The  uterine  hematoma  is  firm,  doughy,  and  gen- 
erally regular  in  outline.  I  have  met  one  old,  greatly  desic- 
cated, tesselated  hematoma  of  the  uterus  which  clinically 
might  well  have  given  trouble  in  diagnosis  and  might  have 
been  mistaken  for  the  skeleton  of  a  fetus.  But  the  crepitus 
is  absent.  The  history  that  the  animal  has  or  has  not  been 
bred  may  aid,  though  this  is  sometimes  erroneous  and  adds 
to  the  confusion.  The  prognosis  in  advanced  fetal  macera- 
tion is  virtually  hopeless  for  the  breeding  life  of  the  ani- 
mal. When  it  has  continued  for  some  months,  the  endome- 
trium is  ordinarily  destroyed  and  the  suppurative  process 
has  extended  into  the  oviducts,  inducing  incurable  pyo- 
salpinx.  I  have  not  known  a  cow  to  conceive  after  having 
suffered  from  prolonged  fetal  maceration.  Possibly  some 
of  them  may  breed. 

The  handling  of  fetal  maceration  offers  many  difficulties. 
The  cervix  is  usually  extensively  inflamed  and  sclerotic,  and 
the  dilation  of  its  canal  is  difficult  and  dangerous.  Forcible 
dilation  is  liable  to  cause  serious  lacerations,  or  the  sclerotic 
tissues  may  rupture,  causing  an  opening  into  the  peritoneal 
cavity.  Uterine  contractions  tending  to  expel  the  cadaver 
may  be  induced  by  dislodging  the  corpus  luteum,  but  the 
corpus  has  sunken  deeply  into  the  center  of  the  gland  (the 
embedded  corpus  luteum  of  pyometra)  and  is  difficult  to 
dislodge.  Sometimes  the  ovary  is  dragged  far  downward 
and  forward  in  a  manner  to  render  it  difficult  to  carry  the 
ovary  back  over  the  vagina  through  the  wall  of  which  vig- 
orous compression  can  be  exerted  without  danger.  The 
corpus  may  be  dislodged  by  compression  per  rectum,  but 
this  requires  extreme  care  in  order  to  avoid  severe  or  dan- 
gerous rectal  lesions.  The  corpus  may  always  be  dislodged 
by  performing  laparotomy,  inserting  the  hand  into  the  peri- 
toneal cavity,  and  compressing  the  ovary  directly.  But  the 
succeeding  uterine  contractions  will  generally  fail  to  expel 
the  cadaver.  The  jagged  bones  become  caught  in  the  uter- 
ine walls,  causing  wounds  and  preventing  expulsion.     The 


484  Diseases  of  the  Genital  Organs 

same  difficulties  face  the  veterinarian  when  he  attempts  to 
bring  about  the  expulsion  by  the  administration  of  pituitary 
extract.  The  contractions  of  the  uterus  can  be  induced, 
but  they  fail  to  evacuate  its  contents.  I  have  removed  the 
skeletal  debris  by  hysterotomy,  but  the  operation  was  diffi- 
cult and  the  result  was  failure.  Possibly  further  efforts  at 
hysterotomy,  or  rather  hysterectomy,  may  develop  a  practi- 
cal technic  associated  with  success.  From  my  experience  I 
believe  the  more  hopeful  plan  to  be  the  amputation  of  the 
involved  horn  with  its  oviduct  and  ovary,  leaving  repro- 
duction to  the  other  horn  and  ovary,  which  may  have 
escaped  hopeless  injury.  When  this  is  undertaken,  great 
care  must  be  exercised  to  avoid  the  escape  of  any  of  the 
uterine  contents  into  the  peritoneal  cavity.  The  abdominal 
incision  must  be  made  upon  the  involved  side  as  far  poste- 
rior as  practicable  upon  the  middle  line  of  the  flank.  That 
is,  the  abdominal  incision  must  be  made  as  near  to  the  uter- 
ine attachments  as  possible.  Even  then,  it  is  difficult  to  lift 
the  involved  uterine  horn  out  through  the  wound,  and  vir- 
tually impossible  to  operate  within  the  abdomen. 

Attempts  at  handling  with  a  view  to  the  restoration  of 
breeding  should  not  be  undertaken  except  in  animals  of 
great  value.  Others  should  be  prepared  for  slaughter  by 
the  most  economic  source.  Where  there  is  old-established 
maceration  of  the  fetus,  the  anim.al  is  frequently  in  good 
beef  condition  and  the  repulsive  skeletal  cadaver  is  so  walled 
off  that  there  is  no  logical  objection  to  the  use  of  the  meat  as 
human  food.  The  uterus  should  be  regarded  as  an  abscess 
cavity. 

(b)  Abscessatio7i  of  the  gravid  idenii^  occurs  when  the 
fetus  macerates  and  the  cervical  canal  undergoes  atresia  to 
such  a  degree  as  to  prevent  the  escape  of  pus  through  the 
genital  passage.  The  occlusion  of  the  cervical  canal  occurs 
by  two  distinct  processes. 

(1)  Ahsceasation  of  the  uterus,  with  fetal  rete)itio)i,  oc- 
curs when  the  fetus  dies  and  the  cervical  canal  becomes 
closed  as  a  result  of  severe  cervicitis.  The  occurrence  is  at 
first  without  notable  clinical  symptoms.     The  animal  has 


Infections  of  the  Ovum,  Embryo  and  Fetus  485 

been  bred  and  is  presumably  pregnant,  but  the  symptoms 
of  advancing  pregnancy  are  absent  or,  if  the  pregnancy  is 
well  advanced  when  the  fetus  dies,  the  symptoms  are  retro- 
grade. In  one  of  my  cases  the  cervical  atresia  was  incom- 
plete and  some  portions  of  the  fetal  membranes  protruded 
from  the  vulva,  but  the  constricted  cervical  canal  afforded 
insufficient  exit.  The  cervical  canal  became  blocked,  possi- 
bly by  a  large  portion  of  the  fetal  cadaver.  The  uterus  ad- 
hered to,  and  finally  opened  into  the  rumen.  Fetal  debris 
passed  into  the  rumen  and  caused  several  attacks  of  fetid 
diarrhea.  Whole  grains  of  corn  (maize)  and  oats  entered 
the  uterus.  The  heifer  suffered  little  in  her  general  health, 
milked  fairly,  grew  fat,  and  was  sold  for  beef.  In  a  second 
case,  from  the  abattoir,  the  uterus  adhered  to  the  urinary 
bladder,  as  illustrated  in  Fig.  172.  The  general  tendency 
appears  to  be  for  the  uterus  to  adhere  to,  and  rupture  into, 
one  of  the  hollow  viscera.  Which  one,  will  depend  some- 
what upon  the  stage  of  pregnancy  at  which  maceration  and 
abscessation  occur.  In  early  pregnancy  the  bladder  or  rec- 
tum forms  the  most  probable  outlet ;  later  in  pregnancy, 
after  the  fetus  drops  forward,  the  rumen  is  the  most  logical 
viscus  into  which  the  uterus  may  empty  its  contents. 

(2)  Uterine  torsion  regularly  causes  occlusion  of  the 
cervical  canal.  Most  patients  die  unless  surgically  relieved, 
but  rarely  the  cow  survives  and  the  fetal  cadaver  macerates. 
In  some  instances  there  occurs  a  transverse  rupture  of  the 
genital  tube  in  the  vagina,  cervix,  or  uterine  body,  and  the 
uterus  with  the  fetus  drops  downward  upon  the  abdominal 
floor.  The  fetus  macerates  but  the  ruptured  end  of  the 
uterus  is  closed  by  the  enveloping  uterine  ligaments  like 
the  mouth  of  a  bag  tied  with  twine.  The  uterine  walls  re- 
tain some  life  through  one  or  more  of  the  uterine  vessels, 
the  organ  adheres  to  the  abdominal  floor,  and  finally  the  ab- 
scess points  externally  and  the  fetid  fetal  debris  drops  out. 
Abscessation  of  the  gravid  uterus  is  hopeless  so  far  as  the 
breeding  life  of  the  animal  is  concerned.  The  adhesions  in- 
cident to  the  abscessation  bring  about  serious  nutritive  dis- 


Diseases  of  the  Genital  Organs 


Fir..  172— Macerating  Embryo  sloughing  into  Urinary  Bladder. 

/,  Cc-rvix  ;  2,  embryonic  debiis  with  i)us  in  l)0(ly  of  uterus  seen  from  above 

'  J,  cornua  ;  ./,  embryonic  debris  in  the  urinary  bhuhler,  after  slouching 

through  its  fundus,  seen  from  right  side  after  sagittal  section  ; 

5,    musrulai-  walls  of  urinary  bladder. 


Infections  of  the  Ovum,  Embryo  and  Fetus  487 

turbances  which  commonly  destroy  the  value  of  the  patient 
for  other  purposes. 

D.  Emphysema  of  the  Fetus 

As  a  rule  the  bacteria  which  infest  the  utero-chorionic 
space  of  the  pregnant  cow,  and  which  tend  to  invade  the 
fetus  and  destroy  its  life,  do  not  form  gases.  Instead  they 
most  frequently  cause  a  dry  necrosis  (necrosis  of  the  tips 
of  the  embryonic  sac)  or  induce  maceration  of  the  fetus. 
The  rapid  multiplication  of  gases  within  the  sealed  uterine 
cavity  or  the  contained  fetus  is  virtually  incompatible  with 
the  life  of  the  mother  unless  the  cervical  canal  is  open  and 
establishes  a  free  vent  for  the  gases.  Usually  the  crisis  of 
uterine  rupture  is  not  reached  because  the  patient  succumbs 
to  sepsis. 

Emphysema  of  the  fetus  occurs  in  all  species  of  animals, 
usually  near,  or  at  the  end  of  the  normal  duration  of  preg- 
nancy. The  emphysema  is  apparently  the  result  of  second- 
ary invasion  of  a  recent  date.  The  life  of  the  fetus  has  or- 
dinarily been  destroyed  and  the  uterine  seal  broken  down  by 
other  invaders,  preparing  an  open  w^ay  for  the  entrance  of 
the  gas  producers.  When  the  fetus  is  emphysematous,  the 
cervical  canal  is  ordinarily  open  but  not  dilated.  Some- 
times, as  in  cases  of  torsion  of  the  uterus  with  emphysema 
of  the  fetus,  the  cervical  canal  is  mechanically  closed  by  the 
torsion.  The  mechanical  injury  to  the  cervix  destroys  its 
resistance  to  invasion,  and  emphysema  results.  Sometimes 
under  these  conditions  the  emphysema  becomes  so  great 
that  the  fetus  occupies  almost  the  entire  abdominal  cavity 
and  rupture  of  the  uterus  appears  to  be  averted  chiefly  by 
the  support  afforded  by  the  contiguous  abdominal  walls. 

The  clinical  symptoms  of  fetal  emphysema  are  essentially 
those  of  the  uterine  gangrene  of  pregnancy  already  de- 
scribed. 

E.  The  Observed  Expulsion  of  the  Fetal  Cadaver.  Abortion 
The  term  ''abortion"  has  a  great  variety  of  meanings.    In 
veterinary  medicine  it  ordinarily  means  the  observed  expul- 
sion of  a  fetal  cadaver.    If  it  is  stated  that  twenty  per  cent. 


488  Diseases  of  the  Genital  Organs 

of  cows  in  a  herd  have  aborted,  it  is  meant  that  someone  has 
observed  one-fifth  of  the  females  expel  fetal  cadavers.  Many 
more  embryonic  or  fetal  cadavers  may  have  been  expelled 
unseen,  or  very  small  embryos  may  have  become  macerated 
and  absorbed,  but  these  are  not  included.  In  this  sense 
"abortion"  has  acquired  a  preeminent  place  in  veterinary 
science  and  the  phenomenon  is  commonly  regarded  as  a 
specific  disease. 

(a)  The  history  of  abortion  is  extensive.  Its  occurrence 
has  been  noted  by  biblical  and  other  early  writers  and  was 
frequently  recorded  in  medieval  times.  The  occurrence  of 
abortion  has  generally  caused  greatest  concern  in  cattle  be- 
cause, since  their  milk  and  meat  have  occupied  a  preeminent 
place  in  the  food  supply  of  most  nations,  any  interference 
with  this  supply  imperils  human  life  and  health.  Perhaps 
the  phenomenon  has  occurred  more  frequently  in  cattle  than 
in  other  domestic  animals  because  the  conditions  favoring 
it  have  been  most  prominent  in  cattle.  Abortion  has  been 
noted  most  in  highly  civilized  countries  with  dense  popula- 
tions where  milk  and  its  derivatives  are  most  highly  prized, 
and  where  any  interruption  of  dairying  causes  a  serious 
shortage  in  this  highly  important  human  food.  Since,  where 
a  regular  daily  supply  is  demanded,  for  economic  reasons  no 
surplus  cattle  are  kept,  any  serious  disturbance  with  milk 
production  is  immediately  felt.  With  the  advancement  of 
civilization  and  concentration  of  population,  the  ratio  of 
milk-  and  meat-producing  animals  to  the  population  becomes 
less  and  higher  eflficiency  of  each  individual  animal  becomes 
essential.  This  increases  the  strain  upon  the  animals,  and 
the  diseases  interfering  with  reproduction  become  more  in- 
tense. Accordingly  abortion  and  other  interferences  with 
reproduction  are  of  ever-increasing  importance  to  the  state 
and  call  for  vigorous  measures  of  control. 

At  first  abortion  was  frequently  attributed  to  unfavorable 
weather,  such  as  unusual  dampness  or  dryness,  to  bad  food, 
to  emanations  from  swamps,  and  to  accident.  In  early  his- 
tory only  a  few  diseases,  such  as  leprosy,  were  attributed 
to  contact.     The  belief  in  contact  as  a  cause  of  disease  ad- 


Infections  of  tJu  Ovum,  Embryo  and  Fetus  489 

vanced  rapidly  during  the  eighteenth  century.  In  the  nine- 
teenth century  Pasteur  and  others  firmly  established  the 
fact  that  disease  is  chiefly  due  to  contact  and  that  the  under- 
lying cause  is  a  living  microparasite  passing  from  the  dis- 
eased to  the  healthy  animal  as  a  result  of  direct  or  indirect 
contact. 

The  belief  in  the  infectiousness  of  abortion  has  experi- 
enced a  long  and  eventful  course  of  development  which  has 
not  yet  been  completed.  For  a  time  a  few  abortions  were 
ascribed  to  infection,  but  these  were  at  first  limited  to  those 
cases  where  ingenuity  failed  to  ascribe  any  other  reason. 
At  present  probably  a  majority  of  people  believe  that  most 
abortions  are  due  to  infection.  The  observed  expulsion  of  a 
fetal  cadaver  came  to  be  regarded  as  a  disease,  and  by  many 
is  still  so  designated.  Those  abortions  believed  to  be  due  to 
contact  accordingly  became  known  as  "contagious,"  "infec- 
tious," or  "epizootic"  abortion  and  were  considered  a  specific 
malady.  Many  believed,  and  still  believe,  that,  if  a  cow 
aborts  as  a  result  of  infection,  it  must  be  due  to  one  infecting 
agent  and  one  only. 

Mammalian  existence  is  divisible  into  two  clearly  defined 
eras — intra-uterine  or  ante-natal,  and  extra-uterine  or  post- 
natal life.  In  post-natal  life  an  indefinite  number  of  infec- 
tions may  threaten  health  or  life.  On  the  other  hand,  it  has 
been  constructively  assumed  that  during  intra-uterine  life 
but  one  bacterium  or  other  microparasite  may  threaten  the 
unborn  animal.  It  is  further  assumed  for  all  practical  pur- 
poses that  an  infection  invading  the  fetus  can  not  cross  the 
birth  line  and  continue  as  a  disease  of  the  calf.  Neither  has 
it  been  commonly  assumed  that  an  infection  of  the  pregnant 
female  can  invade  the  fetus  within  her  uterus.  Technically 
all  pathologists  admit  that  tuberculosis  and  syphilis  may 
pass  from  mother  to  fetus,  but  this  is  not  credited  with  any 
important  bearing  upon  "contagious  abortion."  While  the 
existence  of  such  belief  may  be  technically  denied  by  the 
orthodox  contagious-abortionists,  they  practically  teach  that 
"contagious  abortion"  is  due  to  an  infection  which  acts 
without  contact.    That  is,  if  a  cow  aborts  in  the  presence  of 


490  Diseases  of  the  Genital  Organs 

a  healthy  cow,  the  infection  passes  through  the  body  of  the 
healthy  cow  "in  bond"  and  fatally  attacks  the  intra-uterine 
young,  thus  passing  through  an  intermediary  organism 
without  injury,  to  attack  fatally  a  third  individual. 

In  irreconcilable  conflict  with  such  belief,  the  group  of 
veterinarians  to  which  I  belong  hold  that  the  observed  ex- 
pulsion of  a  fetal  cadaver  is  a  phenomenon  devoid  of  great 
mystery — that  fetal  death  is  fundamentally  like  extra-uter- 
ine death  and  occurs  in  a  perfectly  analogous  way.  Not 
only  is  fetal  death  analogous  to  post-natal  death,  but,  with  a 
single  limitation,  death  in  the  two  eras  is  due  to  identical 
causes.  The  limitation — and  it  is  a  highly  important  one — 
is  that  many  of  the  important  infections  of  post-natal  life 
are  unable  to  attain  contact  with  the  fetus.  The  uterine  seal 
serves  as  an  effective  barrier  against  invasion  through  the 
genital  tract,  and  the  placental  filter,  when  healthy,  is  not 
known  to  permit  the  passage  of  any  organism  competent  to 
cause  disease.  No  such  passage  of  disease-causing  organism 
through  the  healthy  placenta  to  the  fetus  has  yet  been  re- 
corded. Even  the  ultra-minute  disease-producers  which 
defy  the  finest  filter  made  by  man,  such  as  the  virus  of  hog 
cholera,  smallpox,  and  many  others,  do  not  destroy  the  life 
of  the  fetus  directly,  but  only  indirectly  by  destroying  the 
life  of  the  pregnant  female. 

I  have  held  that  the  infections  causing  the  phenomenon  of 
abortion  are  far  less  mysterious  than  generally  claimed  and 
are  in  all  respects  analogous  to,  and  in  an  important  degree 
identical  with,  the  infections  of  extra-uterine  life.  Every 
part  of  the  genital  tract  of  both  sexes  and  of  all  ages  com- 
monly harbors  bacteria  of  great  variety.  Under  ordinary 
conditions  these  may  not  cause  evident  disease,  but  under 
the  numerous  and  vital  changes  of  function  in  the  genital 
tract,  they  may  and  do  acquire  power  to  cause  vital  injury. 
The  uteri  of  most  non-pregnant  and  pregnant  cows  and  heif- 
ers contain  bacteria  having  pathogenic  powers.  The  epi- 
didymes  and  vesiculae  seminales  of  bulls  often  contain  bac- 
teria which  cause  definite  lesions  in  these  parts.  Under 
certain   conditions   such   bacteria   are  ejaculated   with   the 


Infections  of  the  Ovum,  Embryo  and  Fetus  491 

semen  during  coitus.  If  the  cows  served  by  such  a  bull  be- 
come pregnant,  they  largely  abort.  It  is  quite  unnecessary 
to  invoke  mysterious  infections  to  account  for  any  and  all 
abortions.  The  infections  are  present,  abundant,  and  potent. 

(b)  Abortion  is  world-ivide  and  is  seen  in  all  mammalia. 
According  to  the  highest  authorities  upon  human  obstet- 
rics, 25  per  cent,  of  pregnant  women  abort.  Statistically 
the  rate  of  abortion  is  far  less  among  domestic  animals,  but 
that  may  be  statistically  only.  I  have  previously  stated  that 
the  term  abortion,  as  commonly  used,  signifies  the  observed 
expulsion  of  the  fetal  cadaver.  Abortion  statistics  are  neces- 
sarily based  upon  the  observed  phenomenon.  Hence  the 
more  accurate  the  observation,  the  higher  statistically  is  the 
rate  of  abortion.  Such  being  the  case,  if  the  expulsion  of 
the  embryonic  or  fetal  cadaver  were  of  equal  frequency  in 
all  mammalia,  statistically  woman  would  occupy  first  place, 
the  dairy  cow  next,  followed  by  beef  cows  and  other  domes- 
tic females  in  order  of  the  accuracy  of  observation  of  those 
who  are  in  immediate  charge.  Available  statistics  from 
dairy  herds  indicate  that  approximately  10  to  15  per  cent, 
of  pregnant  cows  and  heifers  are  observed  to  abort.  How 
many  fetal  cadavers  are  expelled  unseen  is  pure  guesswork, 
but,  if  the  opportunity  for  observation  were  as  good  as  in 
the  human  family,  the  probabilities  are  that  the  abortion 
rate  in  cows  would  statistically  equal  or  exceed  that  recorded 
for  woman. 

The  phenomenon  of  abortion  is  probably  more  frequent  in 
dairy  than  in  beef  cattle.  Certainly  it  is  more  frequently 
seen,  because  the  dairy  cow  is  under  very  much  closer  ob- 
servation than  any  other  domestic  animal,  except  possibly 
pet  cats  and  dogs. 

If  the  question  is  approached  from  a  diff'erent  angle,  and 
the  reproductive  eflieiency  of  animals  studied,  there  is  far 
greater  accord  between  the  various  species  and  strains.  If, 
for  example,  the  reproductive  efficiency  of  pedigreed  dairy 
and  beef  cows  be  compared,  it  will  be  found  that  there  is  no 
notable  difference.  In  many  pedigreed  beef  herds,  especially 
show  herds,  the  reproductive  ratio  drops  to  50  per  cent,  of 


492  Diseases  of  the  Genital  Organs 

the  ideal  of  one  calf  per  cow  each  year.  Pedigreed  dairy 
herds  ordinarily  do  no  worse.  If  abortion  were  defined  as 
the  failure  to  produce  young,  there  would  be  greater  statis- 
tical harmony  between  the  various  species  and  classes  of 
animals. 

I  have  known  no  herd  of  cattle,  whether  of  dairy  or  beef 
breed,  where  abortion  has  not  been  observed.  I  know  of  no 
authentic  record  of  a  herd  in  which  abortion  is  not  seen. 
The  frequency  of  abortion  varies  widely  in  different  herds 
and  at  different  times.  Abortion  is  one  of  many  phenomena 
due  to  infection  within  the  pregnant  uterus.  If  the  forma- 
tion of  ova  or  spermatozoa  is  prevented  by  infection,  if  the 
genital  cells  are  destroyed  after  being  formed,  or  if  the  fer- 
tilized ovum  or  the  minute  embryo  is  destroyed,  the  disaster 
passes  unseen  and  statistically  becomes  sterility.  Abortion 
is,  therefore,  logically  a  phenomenon  usually  of  the  fifth  to 
the  seventh  month  of  pregnancy,  not  because  the  intra- 
uterine young  perishes  most  frequently,  or  even  so  often, 
at  this  period,  but  because  the  disaster  is  most  frequently 
observed  at  this  time.  After  the  seventh  month,  the  fetus 
may  be  expelled  alive  and  the  phenomenon  is  called  prema- 
ture birth;  a  fetal  cadaver  may  be  expelled  at  full  term  and 
is  called  stillbirth;  or  a  fatally  infected  calf  may  be  born  at 
full  term  and  die  from  intra-uterine  infection,  but  that  is 
known  as  ivhite  scours  or  pneumonia,  or  otherwise.  So  dis- 
ease and  death  throughout  the  entire  reproductive  process 
is  referable  to  a  group  of  infections  and  the  resulting  dis- 
aster is  differently  designated  according  to  the  date  and 
manner  of  its  occurrence,  but  the  final  outcome  is  the  same 
— non-production. 

Abortion  is  the  result  of  two  concurrent  phenomena — the 
death  of  the  fetus,  and  the  existence  of  an  endometritis  of 
the  pregnant  animal  of  such  a  character  as  to  cause  the 
uterus  to  contract  and  evacuate  its  contents.  In  all  recorded 
autopsies  of  cows  which  had  recently  aborted  or  were  in  the 
act  of  aborting  at  the  time  of  slaughter,  there  have  been 
recognized  indisputable  evidences  of  the  presence  of  active 
infoction.     There  has  always  been  a  definite  cervical  endo- 


hifcctions  of  the  Ov2i)u ,  Ei)ibryo  and  Fetrus  493 

metritis  radiating  toward  the  ovarian  end  of  the  uterus. 
Pus  or  other  pathologic  exudate  is  constantly  present  in  the 
utero-chorionic  cavity  or,  if  the  fetal  membranes  have  come 
away,  in  the  uterine  cavity.  The  exudate  and,  almost  al- 
ways, the  alimentary  tract  of  the  fetus  contain  bacteria, 
recognizable  by  cultural  and  staining  methods.  The  utero- 
chorionic  space  of  most  apparently  healthy  pregnant  cows 
and  the  digestive  tube  of  most  new-born,  apparently  healthy 


Fig.  173 — "  The  Exudate  of  Contagious  Abortion." 

Cross  section  through  ihe  cornua  of  a  pregnant  uterus,  showing  exudate 

in  utero  chorionic  space. 

/,  Fetal  sac  in  gravid  horn  ;    2,   fetal  sac  in  non-gravid  horn  ;  j,  exudate  in 

utero  chorionic  cavity  of  gravid  horn  ;  4,  large  masses  of  exudate 

in  non-gravid  horn  ;  5,  section  through  cotyledon. 

calves  contain  bacteria  not  differing  materially  from  those 
observed  in  abortion.  In  abortion,  however,  the  bacteria 
are  far  more  abundant.  The  variation  in  the  abundance  of 
bacteria  is  more  readily  studied  in  the  abort,  the  fetus,  and 
the  calf,  The  amount  of  infection  is  very  notable  in  the 
abort.     The  prematurely  born  calf  usually  bears  in  its  ali- 


494 


Diseases  of  the  Genital  Organs 


Imc.    174— Impending   Abortion,  Cervicitis,     and   Endometritis  at 

Cervical  end,  with  Protrusion  of  Fetal  Sac  into  the  Vagina. 

The  cervix  li;is   l)ecii    laid   open   aloiij;    its  dorsal  surface.      /,  Apparently 

healthy  chorion  ])rotrudinji  into  vagina;  .--.j,  necrotic  portions  of  prolapsed 

chorion  ;  ./,  lips  of   cervix  ;  O,  ri^ht  ovary  ;    C  larjjje  cyst  representing  the 

left  ovary.     Tiie  leftside  is  sterile  ;  the  ri,i.,dit  horn  ].rei,Miant  about  So-godays. 

(See  also  Colored    Plates  III  and  IV.) 


hifedions  of  the  Ovum,  Embryo  a7id  Fetus  495 

mentary  tract  very  voluminous  infection.  When  metritis 
exists,  with  or  without  retained  afterbirth,  the  alimentary 
canal  of  the  apparently  healthy  calf  swarms  with  bacteria 
and  the  calf  probably  breaks  down  with  spesis,  dysentery, 
or  pneumonia.  When  the  cow  calves  vigorously  and  expels 
the  membranes  promptly,  the  infection  in  the  alimentary 
tract  of  the  fetus  is  scant.  All  clinical  and  bacteriological 
evidence  indicates  that  the  abortion  is  in  each  case  referable 
to  infection,  and  to  infection  only. 

In  sharp  conflict  with  all  recorded  evidence,  the  term 
"contagious  abortion"  constructively  suggests  a  non-con- 
tagious abortion.  The  fiction  of  a  non-contagious  abortion 
continues  to  be  supported  by  many  who  believe  that  some 
abortions  are  due  to  various  causes  other  than  infection. 

(c)  Many  believe  in  traumatic  abortion  but  fail  to  ex- 
plain how  mechanical  injury  can  cause  the  death  and  ex- 
pulsion of  a  fetus.  The  bovine  fetus  Hes  upon  the  abdominal 
floor,  surrounded  by  the  abundant  amniotic  fluid  and  almost 
completely  surrounded  by  the  still  more  abundant  allantoic 
fluid  (See  Colored  Plate  I).  The  head  of  the  fetus  gener- 
ally lies  within  the  pelvic  cavity.  If  in  the  posterior  pre- 
sentation, the  head  usually  lies  above  the  sternum  of  the 
cow.  When  the  abdominal  floor  is  struck  at  a  point  against 
which  some  part  of  the  fetus  rests,  it  promptly  floats  away 
in  its  fluids.  Fetal  life  is  not  dependent  upon  the  same 
vital  functions  as  extra-uterine  life.  Since  respiration  and 
nutrition  are  provided  by  the  placentae,  the  sole  vital  func- 
tion of  the  fetus  is  the  fetal  circulation.  Fatal  injury  to 
the  fetus  is,  therefore,  virtually  limited  to  a  traumatism 
which  can  directly  stop  the  fetal  heart -beat.  It  is  not  known 
that  such  injury  is  possible. 

Placental  separation  due  to  mechanical  injury  is  unknown. 
I  have  studied  carefully  in  the  abattoir  the  uteri  of  more 
than  two  thousand  pregnant  cows  and  heifers,  and  have  not 
observed  an  instance  of  any  injury  to  uterus,  fetal  mem- 
branes, or  fetus  which,  had  the  animal  been  permitted  to 
live  might  apparently  have  led  to  abortion.  I  have  already 
described  inter-placental  hemorrhage  with  fetal  desiccation. 


496  Diseases  of  the  Genital  Oroafis 

but  evidently  this  is  not  due  to  mechanical  injury.  It  does 
not  lead  to  abortion,  but  to  fetal  retention.  Hence  it  may 
be  stated  that  up  to  the  present  no  proven  instance  of  me- 
chanical or  traumatic  abortion  has  been  recorded  in  the  cow 
nor  in  any  other  animal,  and  no  logical  explanation  has  been 
put  forward  of  how  mechanical  injury  can  cause  abortion, 
(d)  F'ood  abortion  has  also  been  asserted  to  occur,  and 
every  known  food  has  been  blamed.  The  food  is  alleged  to 
be  too  rich  or  too  poor  in  proteins  or  in  water,  or  it  was  fed 
too  cold  or  in  improper  volume.  Much  has  been  charged  to 
damaged  foods.  Since  nearly  all  foods  are  damaged  some- 
what, bad  food  can  be  made  to  fit  most  cases  of  abortion. 
Special  emphasis  has  been  laid  upon  foods  contaminated 
with  fungi,  such  as  ergot  and  smut,  although  I  can  find  no 
authentic  record  of  experimental  or  other  evidence  of  the 
ability  of  any  fungus  to  cause  a  healthy  female  to  abort. 
McCullom,  Hart,  and  others  have  experimentally  shown 
that,  by  feeding  cows  upon  a  restricted  kind  of  food  (the 
wheat  plant  alone),  although  technically  all  essential  food 
elements  were  given  in  abundance,  the  animals  lost  vigor, 
the  calves  born  of  these  animals  were  weak  and  unthrifty, 
and  as  the  experiments  proceeded,  abortion  ensued,  then 
conception  failed,  and  finally  the  cows  perished.  But  this 
is  the  mere  decadence  of  vigor  due  to  nutritive  disturbance. 
Upon  inquiry  I  was  advised  that  when  the  experiment  cows 
aborted  they  commonly  had  retained  fetal  membranes,  for 
which  up  to  the  present  there  can  be  but  one  explanation — 
the  presence  in  the  uterus  of  an  infection  causing  placentitis. 
The  facts  recorded  by  McCullom  and  Hart  are  of  supreme 
and  vital  interest  to  breeders  of  animals.  Practically  the 
food,  in  a  sense,  caused  the  abortion,  but  the  manner  in 
which  the  food  ration  acted  should  be  carefully  considered. 
It  seems  to  me  evident  that  bacteria  were  present  in  the 
uteri  of  the  experiment  animals  (as  is  commonly  true)  and 
that  the  devitalizing  food  ration  given  so  lowered  the  vitality 
of  the  animals  that  the  resident  infection  increased  in  viru- 
lence and  caused  disaster.  The  contention  that  all  abortions 
are  basically  referable  to  infection  is  neither  an  argument 


Infedioyis  of  the  Ov7im,  Embryo  and  Fetus  497 

nor  admission  that  the  proper  feeding  of  animals  does  not 
play  a  vital  part  in  reproduction.  While  abortion  occurs 
only  in  the  presence  of  intra-uterine  infection,  infection  of 
both  uterus  and  fetus  is  common  without  causing,  or  visibly 
threatening  to  cause  abortion.  The  bacteria  commonly  pres- 
ent in  the  gravid  uterus  and  in  the  contained  fetus  cause  no 
visible  injury  in  many  cases.  If  intra-uterine  bacteria  uni- 
formly prevented  birth,  the  bovine  species  would  soon  be- 
come extinct.  Under  good  hygienic  conditions,  if  the  bac- 
terial content  of  the  uterus  is  low,  a  degree  of  resistance 
may  be  acquired  sufficient  to  hold  in  leash  the  bacteria  pres- 
ent. In  the  presence  of  menstrual  blood  or  of  an  embryo, 
the  virulence  of  the  bacteria  may  increase  and  injury  follow. 
If  the  resistance  of  the  animal  is  lowered  by  faulty  feeding 
or  otherwise,  infection  within  the  utero-chorionic  space  be- 
comes more  active.  The  amount  of  food  may  be  deficient  or 
excessive.  It  may  be  damaged  by  fungi.  The  ration  may 
be  badly  balanced,  or,  as  in  the  experiments  of  McCullom 
and  others,  though  the  food  may  contain  all  necessary  ele- 
ments in  the  quantities  technically  required,  may  fall  short 
in  variety;  then  reproduction  is  faulty  or  absent.  Repro- 
duction is  dependent  upon  a  nutritive  surplus  beyond  other 
body  requirements.  If  the  nutritive  supply  is  barely  suf- 
ficient to  maintain  the  general  functions  of  the  body,  ova 
and  spermatozoa  are  not  formed.  If  the  nutritive  supply  is 
somewhat  greater,  the  reproductive  cells  form,  but  tend  to 
perish  later,  either  before  or  after  fertilization.  In  this  de- 
struction bacteria  play  an  important  part. 

Other  factors  influence  reproduction.  Pregnant  cows  or 
heifers  moved  from  one  establishment  to  another  are  far 
more  liable  to  abort,  to  calve  prematurely,  or  to  suffer  from 
metritis,  probably  with  retained  membranes,  and  the  calf  is 
more  apt  to  suffer  from  dysentery  than  if  the  pregnant  fe- 
males had  been  left  at  home  with  otherwise  equally  good 
care.  The  interferences  with  reproduction  are  not  the  re- 
sult of  inferior  care  nor  of  exposure  to  a  present  infection, 
but  of  the  lowering  of  their  power  of  resistance  to  a  present 
infection.     Twin  pregnancy  is  far  more  liable  to  interrup- 


32 


498  Disea  ses  of  th  c  Gen  it  a  I  Organs 

tion  than  the  normal  single  fetus,  not  because  bovine  (or 
equine)  twins  are  unnatural  but  because  the  increased 
drain  upon  the  nutritive  supply  of  the  mother  lowers  her 
resistance  and  permits  the  intra-uterine  infection  to  multi- 
ply disastrously. 

However  important  food  and  environment  may  be  to  re- 
production, so  far  as  known,  bacterial  invasion  of  the  utero- 
chorionic  space  of  the  cow  is  absolutely  essential  to  abor- 
tion, retained  afterbirth,  and  99  per  cent,  of  sterility. 

(e)  The  biologij  of  abortion.  It  is  now  generally  con- 
ceded technically,  though  largely  denied  practically,  that 
abortion  may  be  caused  by  an  unknown  variety  of  bacteria. 
Any  microorganism  which  may  exist  within  the  pregnant 
uterus,  and  which  is  capable  of  causing  metritis  and  the 
death  of  the  fetus,  may  cause  abortion.  Chronologically  the 
chief  infections  which  have  been  alleged  to  cause  an  im- 
portant amount  of  abortion  in  cows  are  as  follows : 

(1)  The  micrococcus  and  short  bacillus  of  Nocard.'  In  his 
researches  Nocard  recognized  a  short  bacillus  (probably 
paracolon  or  paratyphus)  and  a  micrococcus  in  the  utero- 
chorionic  space  of  aborting  cows,  and  in  the  digestive  tube 
of  the  abort.  He  concluded  that  one  or  both  organisms 
found  were  the  cause  of  abortion  in  the  cases  investigated 
by  him.  He  believed  that  abortion  was  primarily  a  disease 
of  the  fetus,  but  that  the  infection  was  derived  from  the 
uterus.  He  further  expressed  the  very  important  view  that, 
if  the  invaders  failed  to  kill  the  fetus,  they  persisted  in  the 
individual  through  birth  into  extra-uterine  life  and  consti- 
tuted the  basic  cause  of  dysentery  in  young  calves,  thus  as- 
serting his  belief  in  the  continuity  of  infection  between 
intra-  and  extra-uterine  life.  The  views  of  Nocard  were 
virtually  discarded.  Something  more  striking  was  being 
sought  and  demanded.  Lehnert,  in  1878,  and  Brauer,  in 
1880,  believed  that  they  had  promptly  and  reliably  induced 
abortion  by  experimental  infection.  In  England,  also, 
Woodhead,   Aitken,   McFadyean,   Campbell   and   others  as- 

'E.    Nocard.      Avortement   epizooti(iue   dcs    Vaches.      Rec.    de    Med. 

Vet.,  Vol.  Ill,  p.  (;<;<). 


Infections  of  the  Ovum ,  Enibryo  and  Fetus  499 

serted  they  had  experimentally  caused  abortion.  Nocard 
had  made  no  such  claim  for  his  investigations.  Chiefly,  if 
not  wholly  upon  this  ground,  his  work  was  practically  ig- 
nored. It  was  everywhere  demanded  that,  ere  any  given  in- 
fection might  be  accepted  as  a  cause,  or  the  cause,  of  abor- 
tion, its  power  to  cause  abortion  must  be  clearly  demon- 
strated experimentally. 

(2)  The  nodular  venereal  disease  of  Isepponi.'  In  1887, 
Isepponi,  then  Canton  veterinarian  in  Chur,  published  the 
results  of  his  clinical  studies  of  the  hitherto  undescribed  in- 
fectious vaginitis  which  he  thought  a  new  and  rapidly 
spreading  contagion,  and  which  he  believed  to  be  the  cause 
of  the  serious  sterility  and  abortion  in  the  cattle  of  his  dis- 
trict. For  reasons  which  seem  to  me  ample,  I  have  placed 
this  among  the  specific  venereal  diseases  in  Chapter  XII, 
where  it  is  discussed  at  length. 

(3)  The  Bacterium  Abortus  of  Bang. 

In  1896,  Bang  and  Stribolt  discovered  in  the  uterus  of  a 
cow,  destroyed  in  the  act  of  abortion,  a  small  Gram-negative 
bacterium  which  they  succeeded  in  cultivating  in  gelatin- 
agar  serum.  The  finding  of  the  bacterium  in  large  numbers 
in  the  utero-chorionic  space  and  in  the  fetal  cadaver  justi- 
fied a  suspicion  that  it  had  to  do  with  the  abortion.  Bang 
inoculated  seven  cows  with  pure  cultures  of  the  organism. 
Prior  to  inoculating  them,  he  did  not  learn  whether  they 
would  or  would  not  probably  abort  if  left  alone,  and  he  did 
not  know,  and  had  no  means  of  learning,  whether  they  al- 
ready had  the  bacterium  in  their  uteri.  They  were  presum- 
ably taken  from  their  normal  habitat  and  placed  under  ex- 
perimental conditions  favorable  to  abortion,  closely  guarded, 
so  that  the  expulsion  of  a  fetal  cadaver  would  almost  cer- 
tainly be  seen.  One  (14  per  cent.)  of  the  seven  cows 
aborted,  which  rate  is  no  higher  than  would  be  expected 
without  inoculation.  Her  uterus  contained  a  bacterium  not 
differentiable  from  the  one  used  for  inoculation. 

'Beitrag-e  z.  d.  Ursach.  d.  Unfruchtbarkeit  d.  Kiihe.  Schw.  Archiv. 
fur  Tierheilkunde,  1887. 


500  Diseases  of  the  Genital  Orgajis 

So  much  emphasis  has  been  placed  upon  the  power  of  the 
B.  abortus  of  Bang  to  cause  abortion  during  the  pregnancy 
existing  at  the  time  of  inoculation,  that  a  brief  review  of  the 
recorded  evidence  is  permissible. 

The  Experimental  Evidence  of  the  Power  of  B.  Abortus 
TO  Cause  Abortion 

The  dictum  of  Bang',  "Through  these  two  experiments 
we  have  submitted  the  complete  proof  that  the  bacilli  dis- 
covered by  us  are  the  cause  of  epizootic  abortion,"  has 
exerted,  and  still  exerts  a  profound  influence  upon  the  cur- 
rents of  thought  regarding  abortion  in  animals.  Two  basic 
ideas  are  included  in  the  quotation  from  Bang.  First,  abor- 
tion is  a  specific,  contagious  disease,  like  tuberculosis  or 
smallpox,  caused  always  by  one  and  the  same  organism  and 
by  one  microparasite  only.  Second,  the  bacillus  described 
by  Bang  is  the  cause  and  the  onhj  cause  as  proven  by  his  ex- 
periments. 

For  many  years  the  dictum  of  Bang  was  generally  ac- 
cepted without  reservation.  Cattle  abortion  was  regarded 
as  a  specific  disease  apart  from  all  other  diseases  of  cattle, 
and  the  B.  abortus  was  considered  the  specific  agent.  It  is 
confidently  stated  that  Bang  and  Stribolt  "produced  abor- 
tion in  cows  with  it  {B.  abortus)";  "The  fact  seems  to  be 
clearly  established  that  the  specific  cause  of  infectious  abor- 
tion in  cattle  is  the  organism  isolated  by  Bang  and  Stribolt"  ; 
"That  the  Bacillus  abortus  of  Bang  is  capable  of  producing 
abortion  experimentally  in  cattle  by  feeding  and  by  intra- 
venous injections  has  been  satisfactorily  proven  by  Bang, 
McFadyean  and  Stockman,  Macneal  and  Kerr.  Good,  and 
others" ;  "Abortion  disease  is  a  specific  infectious  disease 
which  is  caused  by  a  small  germ  known  as  the  Bacillus  abor- 
tus of  Bang" ;  "The  cause  of  abortion  is  a  short,  oval-shaped 
germ  (Bact.  abortus)";  "The  inoculation  of  pregnant  cattle 

.    .    .    produces  abortion  after  a  variable  length  of  time" ; 

'"Durch  diese  beiden  Versuche  haben  wir  soniit  don  vollen  Beweis 
dafiir  ^efuhrt,  dass  die  von  uns  {""efundonen  BacillcMi  die  Ursacho  des 
.seuchenhaften  Verwerfens  sind." 


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502  Diseases  of  the  Genital  Organs 

"A  microorganism  or  minute  germ  (the  abortion  bacillus 
of  Bang)  is  known  to  be  the  sole  cause  of  contagious  abor- 
tion." 

Such  positive  assertions  that  the  specific  character  of 
cattle  abortion  has  been  absolutely  proven  experimentally 
and  that  the  Bacterium  abortus  is  the  cause,  have  served  to 
prevent  a  critical  examination  of  the  evidence  v^^hich  has 
been  alleged  to  prove  the  specific  abortifacient  action  of  the 
B.  abortus.  Most  writers  upon  abortion  in  cattle  refer  to 
the  experimental  production  of  abortion  in  pregnant  cattle 
as  the  corner  stone  for  the  positive  statements  that  the  B. 
abortus  is  the  specific  agent  in  abortion.  Little  has  been 
written  concerning  the  actual  recorded  evidence. 

In  the  succeeding  table  the  available  recorded  data  of  the 
experimental  efforts  at  producing  abortion  with  the  B. 
abortus  have  been  assembled,  with  direct  and  indirect  con- 
trols. Numerous  objections  may  be  urged  against  their 
fairness.  Tabulation  demands  brevity  and  inevitably  leaves 
opportunity  for  misconception. 

(1)  The  seven  animals  consisted  of: 

a.  Two  pregnant  cows  inoculated  in  vagina  with  pure  cul- 

tures and  killed,  one  nineteen  days,  the  other  twenty- 
nine  days  after  inoculation. 

b.  Two  pregnant  cows  inoculated  per  vaginam  with  after- 

birth from  an  aborter,  the  one  killed  thirty-three,  the 
other  thirty-five  days  after  exposure. 

c.  Two  pregnant  cows,  four  and  seven  years  old,  a  second 

inoculation  being  made  thirty-nine  days  later,  and  a 
third  dose  twelve  days  after  the  second.  Seventy-one 
days  after  the  first  inoculation,  the  seven-ycav-old  cow 
aborted  a  five-months  fetus.  B.  abortus  and  a  micro- 
coccus were  found  in  the  placenta. 

d.  A  six-year-old  cow  was  inoculated  per  vaginam  with  pure 

cultures.  She  calved  eighty  days  later.  B.  abortiia 
bacilli  were  found  in  uterine  contents  of  the  cow. 

(2)  Out  of  the  twenty-eight  experiments  recorded  by  McFadyean 

and  Stockman,  Experiments  Nos.  7,  14,  15,  18,  22,  24  and  25 
(7)  were  followed  by  abortion.  In  Experiment  13  the  fetus 
underwent  desiccation  following  death  but  was  not  expelled. 
Other  animals  were  killed  prior  to  the  termination  of  prog- 
nancy,  and  some  might  have  aborted  had  they  not  boon  killed. 


Infections  of  the  Ovum,  Embryo  and  Fetus  503 

(3)  Thirty-nine  heifers  in  first  pregnancy  were  alleged  to  have  been 

chased  by  a  dog.  Some  months  later  eleven  of  them  aborted. 
McFadyean  testified  that  the  abortions  were  not  due  to  con- 
tagion. 

(4)  These  experiments  were  carried  out  under  the  auspices  of  Sir 

Stewart  Stockman  with  material  furnished  by  the  Board  of 
Agriculture  and  Fisheries. 

(5)  The  nine  cows  were  all  recent  purchases.     Five  came  from  a 

herd  where  abortion  had  raged  the  previous  year  and  were 
all  pregTiant  when  bought.  Two  had  aborted  the  previous  year, 
two  were  sterile  or  had  aborted  unseen,  and  one  had  calved. 
After  inoculation  all  aborted.  The  history  of  the  other  four 
was  unknown.  Three  were  pregnant  when  purchased,  the 
foui-th  was  bred  after  buying.  All  nine  were  recent  arrivals 
on  the  experimental  premises,  which  increased  the  tendency 
to  abort. 

(6)  The  heavy  percentage  of  abortions  in  inoculated  cows  is  caused 

by  the  high  rate  of  the  five  cows  of  Moore,  only  one  of  which 
was  knovvTi  to  have  calved  the  previous  year. 

(7)  The  100  per  cent,  of  abortions  in  controls  is  admittedly  of  no 

moment,  but,  since  the  one  heifer  is  the  only  control  of  which 
I  can  find  record,  the  figures  are  technically  correct. 

(8)  The   Thurebylille  herd  consisted   of  about  130  milk   cows   and 

about  30  heifers,  and  the  data  extend  from  1885  to  1896,  in- 
clusive, or  a  period  of  twelve  years. 

(9)  The  data  given  here  are  for  uninoculated  cows  and  heifers  kept 

as  controls  in  vaccination  against  abortion,  as  shown  in 
Table  IV,  page  353,  Report  Tenth  International  Veterinary 
Congress. 

(10)  Owing  to  errors  in  diagnosis.  Bland  unintentionally  inoculated 

five  pregnant  cows  and  nine  pregnant  heifers  with  living 
bacilli.  (Herd  A,  two  cows,  four  heifers;  Herd  M,  one  cow; 
Herd  Q,  one  cow;  Herd  R,  one  cow;  Herd  B2,  five  heifers. 
Total,  fourteen.) 

(11)  The  two   cows   which    aborted   following   inoculation   had   also 

aborted  in  the  pregnancy  before  inoculation.     See  also    (5). 

(12)  Bland,  on  page  9  of  his  first  report  in  his  experiments  to  con- 

trol abortion  by  vaccinating  the  non-pregnant  animal,  kept 
as  "controls"  296  non-pregnant  cows  and  heifers,  thirteen  of 
which  were  not  known  to  have  conceived.  Bland's  percentage 
of  abortion  (18.2)  is  based  upon  296  animals,  while  the  per- 
centage here  given  (19.1)  is  based  upon  296 — 13,  283  animals. 

(13)  Second  report,  page  15. 

(14)  In  the  Bland  reports  the  number  of  animals  of  prior  year  is 

not  given  and  total  under  experiment  is  used,  with  percent- 
ages for  prior  years. 


504  Diseases  of  the  Genital  Organs 

(15)  The  data  cover  twenty-two  years,  217  cows  and  heifers  and  the 

645  pregnancies  recorded. 

(16)  The  data  cover  thirty-one  months. 

(17)  The  data   cover   ten   years   and    include   sixty-seven    cows   and 

heifers. 

Bibliography 
I.  Bang,  Prof.  B.,  Die  Aetiologie  des  seuchenhaften  ("infec- 
tiosen")  Vei-werfens,  Zeitschrift  f.  Tiermedicin,  Vol.  I,  p. 
241. 
II.  McFadyean  and  Stockman,  Rep.  Departmental  Com.  Bd.  of 
Ag.  and  Fisheries,  Great  Britain,  on  Epizootic  Abortion, 
1909. 

III.  Testimony  of  Sir  John  McFadyean  in  litigation  of  Chadwick 

vs.  Gorman,  Vet.  Rec,  March  30,  1912,  p.  621. 

IV.  Stockman,   Sir  Stew^art,  Epizootic  Abortion,  Rep.  Tenth  In- 

ternational Veterinary  Congress,  Vol.  II,  p.  343. 
V.     Bland,  G.  R.,  First  and  Second  Reports  by  the  Agricultural 
Organizer    of    Oxford    County,    England,    on    the    Epizootic 
Abortion  Experiments  carried  out  in  27  herds,  1911  to  1916, 
Oxfordshire,  England. 
VI.     Moore,  V.  A.,  and  Fitch,  C.  P.,  Rep.  N.  Y.  State  Vet.  Col.  at 

Cornell  University,  1912-1913,  p.  89. 
VII.     Williams,  W.  L.,  Rep.  N.  Y.  State  Vet.  Col.  zi  Coinell  Univer- 
sity, 1911-1912,  p.  79. 
VIII.     Williams,  W.  L.,  The  Granular  Venereal  Disease  and  Abor- 
tion in  Cattle.     Bulletin  of  the  U.   S.   Dept.  Agr.,  No.   106, 
Sept.  12,  1914,  p.  49. 
IX.     Williams,  W.  L.,  Abortion  and  Sterility  in  Cattle.    Rep.  N.  Y. 
State  Vet.  Col.  at  Cornell  University,  1913-1914,  p.  136. 

X.  Williams,  W.  L.,  Abortion  and  Sterility  in  Cattle.    Rep.  N.  Y. 

State    Vet.    Col.    at    Cornell    University,    1911-1912,    p.    85, 
Herd  A. 

XI.  Williams,  W.  L.,  Abortion  and  Sterility  in  Cattle.    Rep.  N.  Y. 

State    Vet.    Col.    at    Cornell    University,    1911-1912,    p.    87, 
Herd  B. 
XII.     Williams,  W.  L.,  Abortion  and  Sterility  in  Cattle.     Rep.  N.  Y. 
State    Vet.    Col.    at    Cornell    University,    1911-1912,    p.    87, 
Herd  C. 
As  early  as  1912  (VII),  I  made  the  following  statement: 
"It  has  not  been  clearly  shown  that  a  like  number  and  kind 
of  pregnant  cattle  would  not  have  aborted  had  sterile  salt 
solution  been  substituted  for  the  Bang  organism." 

A  critical  study  of  the  tabulated  data  bears  out  this  asser- 
tion: 


Infections  of  the  Ovum,  Embryo  and  Fetus  505 

The  21  cows  used  for  experimental  inoculation  show  the 
largest  ratio  (52.4Vr )  of  observed  abortion.  Of  the  11 
aborters,  however,  4  (Bland,  2;  Moore,  2)  are  known  to 
have  aborted,  and  2  (Moore)  were  sterile  or  aborted  unseen 
the  prior  year.  Only  1  of  those  aborting  (Moore)  is  known 
to  have  calved  the  previous  year  and  1  (Bang)  may  have 
done  so.  Omitting  the  4  known  aborters  and  the  2  sterile 
cows  of  the  previous  year,  there  remain  15  cows  which  pos- 
sibly calved  the  prior  year,  and  of  these,  5  {23.8% )  aborted. 
No  controls  were  kept  and  the  ratio  is  not  sufficiently  high 
to  constitute  good  evidence.  It  is  not  known  that  each  of  the 
cows  did  not,  when  the  inoculation  was  made,  carry  in  the 
utero-chorionic  cavity  an  infection  capable  of  causing  abor- 
tion. In  the  one  Moore  cow,  in  the  group  of  5,  this  is  not 
merely  a  possibility  but  a  definite  probability,  since  she 
came  from  the  same  herd  as  the  other  4,  none  of  which 
calved  the  previous  year. 

A  study  of  the  available  records  of  experimental  inocula- 
tion in  heifers,  of  which  it  has  been  possible  to  assemble  48, 
shows  that  10  (20.8Vy  )  are  recorded  as  having  aborted.  I 
find  only  one  heifer  recorded  as  having  been  kept  directly 
as  a  control — that  in  my  experiment  (IX) — and  that  one 
aborted.  A  single  case  can  not  be  accepted  as  conclusive 
nor  as  valuable  evidence,  but  there  is  no  other  way  of  stat- 
ing the  recorded  fact.  The  question  of  controls  has  been 
ignored. 

The  heifers  in  the  Bland  experiments  (V)  were  not  in- 
oculated to  cause,  but  to  prevent  abortion.  The  inoculation 
occurred  through  error.  The  heifers  were  assumed  to  be 
non-pregnant  at  the  date  of  inoculation,  but  later  proved  to 
be  pregnant.  These  are  inserted  in  the  table  under  the  as- 
sumption that  the  effect  was  the  same  whether  the  inocula- 
tion was  made  to  cause  or  to  prevent  abortion.  The  virtual 
controls  of  Bland — (12),  (13) — should  be  applicable,  as 
they  were  definitely  used  as  controls  in  efforts  to  prevent 
abortion  by  vaccination  of  non-pregnant  cattle  with  living 
bacilli. 


5o6  Diseases  of  the  Genital  Organs 

The  more  voluminous  data  regarding  the  frequency  of 
observed  abortions  in  herds  show  a  higher  rate  generally 
than  that  recorded  in  experimental  inoculations.  The  ex- 
ception is  the  data  submitted  by  Bang  showing  but  7  per 
cent,  in  cows  of  the  Thurebylille  herd.  When  the  data  upon 
heifers  in  first  pregnancy  are  examined,  it  is  found  that 
under  the  prevailing  conditions  in  herds  the  ratio  of  ob- 
served abortions  (52.55',  )  is  far  in  excess  of  the  recorded 
abortions  following  experimental  inoculations.  When  cows 
and  heifers  are  taken  together,  the  observed  abortions 
(199^)  are  but  1.08  per  cent,  below  the  ratio  reported  in  the 
experimentally  inoculated  animals. 

The  objection  to  these  data  may  be  urged  that  they  are 
from  "infected"  or  "badly  infected"  herds,  but  no  data  are 
available  from  non-infected  herds.  One  often  hears  of  non- 
infected  herds,  but  any  attempt  to  get  in  contact  with  such 
and  secure  accurate  data  for  record  leaves  one  with  the 
feeling  that  he  has  been  pursuing  a  mirage.  If  there  are 
herds  in  which  no  abortions  occur  and  in  which  each  cow  or 
heifer  of  breeding  age  produces  a  healthy  calf  each  twelve 
months,  the  failure  of  those  having  knowledge  of  the  facts 
to  publish  the  details  serves  as  an  impassable  barrier  to  their 
use.  The  question  can  be  judged  or  decided  only  upon  the 
available  recorded  data. 

The  further  and  pertinent  objection  may  be  made  that  in 
many  of  the  experiments  the  animals  were  destroyed  prior 
to  the  termination  of  pregnancy  and  that  some  or  many  of 
these  might  have  aborted  had  they  not  been  killed.  But  it 
would  be  equally  erroneous  to  pick  out  from  the  total  those 
animals  kept  until  after  termination  of  pregnancy  and  ac- 
cept the  results  in  this  group  alone.  The  probability  of 
abortion  decreases  as  the  duration  of  pregnancy  advances : 
the  disease  may  be  present  and  severe  but  may  result  in 
premature  birth,  in  retained  afterbirth,  or  in  calf  scours  or 
pneumonia. 

On  the  other  hand,  it  may  be  very  properly  maintained 
that  the  animals  slaughtered  prior  to  the  termination  of 
pregnancy  were  generally  held  beyond  the  alleged  "period 


Infections  of  the  Ovum,  Embryo  and  Fetus  507 

of  incubation"  of  the  abortion  infection  and  should  mostly, 
according  to  the  constructive  standards  of  various  experi- 
menters, have  aborted  prior  to  slaughter  if  they  were  to 
abort. 

Some  investigators  have  also  argued  that  the  finding  of 
the  B.  abortus  in  the  uterine  cavity  of  the  killed  animal  is 
experimental  proof  that  it  is  the  cause  of  abortion.  If  that 
is  true  of  the  B.  ahortus,  then  it  must  be  equally  true  of  all 
the  other  microparasites  found  in  the  uteri  of  pregnant 
cows.  It  can  he  experimentally  proven  that  a  given  organ- 
ism causes  a  cow  to  abort  only  by  those  cases  ivhich  actually 
abort.  It  is  not  necessary  to  produce  infection  of  the  utero- 
chorionic  space  in  a  pregnant  cow  to  show  that  the  B. 
abortus  is  capable  of  causing  such  infection;  Bang  proved 
that  in  the  first  cow  in  which  he  recognized  the  bacillus. 
If  it  existed  and  multiplied  in  that  cow,  it  follows,  a  priori, 
that,  implanted  in  another  pregnant  uterus  of  identical 
species  and  power  of  resistance,  it  would  cause  infection 
again. 

It  has  been  attempted  to  apply  to  abortion  the  postulates 
of  Koch  who  assumed  as  a  basis  for  experimentally  proving 
the  specific  character  of  a  bacillus:  (1)  The  organism 
needs  to  be  obtained  in  pure  cultures.  (2)  Inoculation  of  a 
sound  animal  with  pure  cultures  must  cause  the  typical 
symptoms  and  lesions  observed  in  naturally  infected  ani- 
mals. (3)  Pure  cultures  of  the  organism  must  be  recov- 
ered from  the  tissues  of  the  experimentally  inoculated  and 
diseased  animal.  Koch's  postulates  are  inapplicable  to 
abortion  in  cattle  because  the  abortion  is  not  the  disease  nor 
is  it  a  lesion ;  it  is  merely  one  of  the  possible  occurrences  in 
the  course  of  a  disease  having  the  power  to  destroy  the  life 
of  a  fetus  and  to  irritate  the  pregnant  uterus  in  a  manner 
to  cause  it  to  expel  the  fetus.  While  the  data  submitted 
fail  to  justify  the  dictum  of  Bang  and  others  that  the  inocu- 
lation of  a  pregnant  cow  or  heifer  with  the  Bang  organism 
will  cause  her  to  abort  during  the  existing  pregnancy  and 
thus  prove  that  the  B.  abortus  is  the  specific  cause  of  abor- 
tion in  cattle,  it  is  not  proof  that  such  inoculation  is  without 


5o8  Diseases  of  the  GeJiital  Orgayis 

injurious  result.  Neither  does  it  prove,  nor  tend  to  prove, 
that  abortion  is  not  sometimes  or  frequently  caused  by  the 
Bang  organism. 

I  have  long  held  that  any  attempt  to  prove  experimentally 
that  a  given  organism  is  the  cause  or  a  cause  of  an  abortion 
occurring  during  the  pregnancy  in  which  the  inoculation 
was  made,  is  unwarranted  and  misleading.  When  Bang 
discovered  the  bacterium  which  he  described,  he  definitely 
showed  that  it  was  an  intra-uterine  and  fetal  infection.  No 
beneficent  office  could  be  ascribed  to  it.  If  capable  of  ex- 
isting in  vast  numbers  in  the  one  cow  and  fetus,  it  might 
equally  well  exist  in  equally  great  numbers  in  other  uteri 
and  fetuses  of  the  same  species  and  of  similar  constitution. 
There  was  present  metritis,  for  which,  under  ordinary  sur- 
roundings, no  cause  except  infection  is  known.  Bang  recog- 
nized in  the  uterus  an  infection.  If  this  was  the  only  bac- 
terium present  or  recognizable  (upon  which  point  Bang  is 
not  clear)  the  only  justifiable  conclusion  at  which  he  could 
arrive  was  that  the  bacterium  in  question  was  the  cause  of 
the  abortion.  Bacterial  search  of  the  uterus  of  another 
aborting  cow  in  which  some  other  microorganism  was  found 
would  not  vitiate  nor  influence  the  conclusion  reached  upon 
the  one  described. 

Abortion  is  not  a  disease  nor  the  symptom  of  any  one  dis- 
ease. So  far  as  the  fetus  is  concerned,  abortion  is  death, 
and  death  is  a  result  common  to  all  diseases.  The  fact  that 
an  adult  dies  is  not  proof  that  it  has  anthrax,  and  the  fact 
that  a  fetus  dies  is  not  proof  that  it  was  killed  by  B.  abortus. 
In  so  far  as  the  pregnant  female  is  concerned,  abortion  indi- 
cates endometritis  at  the  cervical  end  of  the  uterus.  Me- 
tritis exists  in  non-pregnant  and  pregnant  heifers,  in  preg- 
nant cows,  in  cows  in  the  puerperal  stage  and  during  the 
interval  of  rest  between  a  period  of  calving  and  the  next 
conception.  The  character  of  the  metritis  which  may  occur 
at  any  period  in  the  life  of  the  female  varies  infinitely  and 
the  number  of  bacteria  capable  of  causing  the  metritis  is 
unknown.  A  few  instances  of  metritis  stand  apart,  such 
as  that  of  uterine  actinomycosis  and  tuberculosis.     They 


Infections  of  the  Ovum,  Embryo  and  Fetits  509 

are  specific.  But  the  metritis  met  in  essentially  all  cases  of 
abortion  bears  no  mark  by  which  it  can  be  assigned  to  any 
one  bacterium.  Consequently  if  several  bacteria  are  pres- 
ent, there  is  nothing  in  the  metritis  to  indicate  which  of  the 
invaders  is  responsible. 

Any  contagion  competent  to  injure  or  destroy  an  adult 
may,  so  far  as  known,  equally  imperil  the  life  of  an  ovum, 
embryo,  or  fetus  if  contact  occurs.  The  vast  majority  of 
infections  do  not  and  can  not  reach  the  intra-uterine  young. 
The  opening  of  the  genital  tract  through  the  vulva  is  her- 
metically sealed  at  the  cervical  canal  by  the  uterine  seal.  It 
is  not  known,  and  there  is  no  reason  to  suspect,  that  bacteria 
can  traverse  the  cervical  canal  and  enter  the  utero-chorionic 
space  of  the  pregnant  cow  while  the  uterine  seal  is  intact. 
The  mammalian  placenta,  so  long  as  intact,  is  not  known  to 
permit  the  passage  of  any  form  of  pathogenic  organism. 
It  has  not  been  shown  that  any  disease-producing  organism 
passes  during  pregnancy  from  the  blood  system  of  the 
mother  into  the  utero-chorionic  space.  Infection  is  not 
known  to  invade  the  uterine  cavity  of  the  pregnant  female 
through  the  oviducts.  There  is  accordingly  no  portal  of 
entry  into  the  sealed  uterus  of  pregnancy  through  which 
bacteria  have  been  known  to  enter.  The  orthodox  con- 
tagious-abortionists positively  assert  that  the  B.  abortus 
enters  the  uterus  during  pregnancy,  but  avoid  stating  by 
what  avenue  the  invasion  occurs. 

I  have  held  that  the  infections  which  prevent  or  interrupt 
reproduction  invade  the  uterus  prior  to  the  sealing  of  the 
cervical  canal ;  either  the  infection  was  present  in  the  uterus 
at  the  time  of  coitus,  or  it  was  introduced  during  that  act. 

The  frequency  of  abortion  in  a  herd  usually  corresponds 
fairly  well  with  the  intensity  of  infection  by  B.  abortus. 
In  those  herds  where  abortion  and  other  interferences  with 
reproduction  are  common,  the  agglutination  and  comple- 
ment-fixation tests  usually  show  intense  infection  with  B. 
abortus.  But  such  reactions  can  only  show  that  the  B. 
abortus  is  somewhere  active  (or  has  been  active)  and  can 
not  show  that  it  caused  a  given  abortion.     If  such  tests 


5IO  Diseases  of  the  Genital  Organs 

could  show  that  B.  abortus  has  caused  a  given  abortion,  a 
typical  reaction  of  an  aborting  cow  to  the  tuberculin  test 
would  show  that  the  abortion  was  due  to  the  infection  of 
tuberculosis.  I  have  seen  a  high  B.  abortus  agglutination 
reaction  in  a  sterile  heifer  never  known  to  have  conceived, 
in  which,  upon  autopsy,  B.  abortus  was  recovered  from  the 
udder  but  not  from  the  genital  tract.  The  sterility  was  ap- 
parently due  to  streptococcic  salpingitis.  Doubtless  her 
blood  would  also  have  reacted  strongly  to  the  streptococcus. 
In  the  researches  in  my  department,  the  blood  of  cows  in 
which  harmful  genital  infections  exist  reacts  to  several 
species  of  bacteria,  such  as  paracolon  and  streptococci,  but 
the  reactions  show  merely  the  presence  of  such  bacteria 
somewhere  in  the  body,  and  can  not  show  that  they  cause 
sterility  or  abortion.  The  agglutination  test  for  the  pres- 
ence of  B.  abortus  is  in  itself  fundamentally  defective.  I 
injected  living  B.  abortus  cultures  in  the  jugular  vein  of  a 
two-year-old  pregnant  heifer.  She  probably  already  had  B. 
abortus  in  her  utero-chorionic  cavity.  The  agglutinating 
power  of  her  blood  was  followed  from  0.02  up  to  0.001  and 
in  its  descent  until  minus  at  0.02.  Then  she  aborted  and 
was  promptly  destroyed.  Her  blood  was  negative  at  0.02, 
and  her  uterus  was  swarming  with  B.  abortus. 

A  vital  defect  of  the  agglutination  test  for  the  presence  of 
B.  abortus  is  the  total  absence  of  knowledge  of  the  physi- 
ologic agglutinating  power  of  bovine  blood.  Some  consider 
an  agglutination  at  0.02  as  proof  of  infection ;  others  place 
the  infection-point  at  0.01.  As  a  rule  the  blood  of  new-born 
calves  is  negative  at  0.1  and  can  be  held  there  experimentally 
as  long  as  I  have  cared  to  do  so.  If  the  calf  is  fed  in  the  or- 
dinary manner,  its  blood  commonly  reacts  positively  at  0.1 
or  higher  within  thirty  days.  I  have  seen  it  react  at  0.002 
at  thirteen  days.  The  common  practice  of  fixing  upon  0.02 
or  0.01  as  denoting  infection  is  absolutely  arbitrary  and  un- 
supported by  any  recorded  attempt  at  justification.  There 
is  no  more  reason  for  believing  that  agglutination  at  0.02 
or  0.01  denotes  infection  than  for  declaring  that  agglutina- 
tion at  0.04  or  0.1  indicates  infection. 


Infections  of  the  Ovum,  Embryo  and  Fetus  511 

(4)  The  Paratyphoid  Bacillus  of  Moussu^ 

Moussii  declares,  apparently  upon  adequate  grounds,  that 
in  a  large  section  of  France  much  abortion  is  due  to  a  short 
bacillus  of  the  colon  group.    The  B.  abortus  is  absent. 

(5)  The  Spirillum  of  Smith-  and  Others 

Smith,  in  studying  a  series  of  aborts  from  a  large  dairy 
herd,  obtained  pure  cultures  of  B.  abortus  in  27  (66%)  and 
a  spirillum  or  vibrio  in  14  (34%).  In  other  aborts  Smith 
failed  to  find  either  the  B.  abortus  or  the  spirillum,  but  rec- 
ognized bacteria  belonging  to  the  colon  and  other  groups. 
The  lesions  in  the  aborts  did  not  vary  with  the  variations  of 
the  bacteria  present,  but  were  fundamentally  alike  in  all. 

(6)     Miscellaneous  Bacteria 

Isolated  cases  of  abortion  have  been  attributed  to  various 
bacteria  other  than  those  mentioned  above.  A  few  have 
been  attributed  to  B.  pyogenes.  Bacterial  search  of  the 
tubo-utero-cervical  canal  reveals  a  great  variety  of  infec- 
tions present  in  non-pregnant  and  pregnant  animals.  A 
streptococcus  of  the  viridans  group  is  dominant  apparently 
in  serious  tubal  infections  and  perhaps  plays  an  essential 
role  in  the  necrosis  of  the  apices  of  the  embryonic  sac. 
Probably  it  causes  the  death  of  many  fertilized  ova  and  of 
embryos. 

F.  The  Nature  of  Abortion 
The  belief  that  abortion  is  generally  due  to  a  specific  con- 
tagion of  the  pregnant  uterus  and  its  contents,  inevitably 
involves  the  belief  that  the  infection  can  not  exist  in  the  gen- 
ital tract  prior  to  conception  and  that  it  must  cease  to  exist 
with  the  termination  of  pregnancy.  Neither  can  the  alleged 
specific  infection  cause  other  results  than  abortion.  Hence 
the  orthodox  believer  in  the  specific  character  of  abortion  de- 

^Prof.  G.  Moussu.  Sur  rAvortement  Epizootique.  Tenth  Internat. 
Vet.  Cong.,  1914. 

-Theobald  Smith.  Spirilla  associated  with  Disease  of  the  Fetal 
Membranes  in  Cattle.    Jour.  Exp.  Med.,  Dec.  1,  1918. 


512  Diseases  of  the  Geyiital  Organs 

nies  that  the  infection,  sometimes  leading  to  abortion,  can 
cause  sterility,  retained  afterbirth,  or  metritis  other  than  the 
specific  metritis  of  contagious  abortion,  which  must  cease  to 
exist  at  the  termination  of  pregnancy,  to  be  succeeded  by 
another  metritis  due  to  other  infection.  So  with  the  fetus 
and  the  calf.  The  fetus  is  invaded  by  "the  specific  infection 
of  contagious  abortion,"  but  after  the  calf  is  born  such  in- 
fection must  terminate,  though  the  calf  may  promptly  die 
from  sepsis,  dysentery,  or  pneumonia,  and  though  bacteria 
which  can  not  be  diflferentiated  from  those  existing  in  the 
digestive  tract  of  the  fetus  are  present  in  that  of  the  new- 
born calf  and  apparently  cause  the  serious  or  fatal  disease. 
This  group  of  writers  use  constantly  the  definite  article 
"the"  in  connection  with  the  alleged  specific  contagion,  thus 
excluding  all  other  infections  or  contagions  as  possible 
causes  of  abortion.  That  is,  if  the  B.  abortus  of  Bang  is  the 
cause  of  contagious,  infectious,  or  epizootic  abortion  in 
cattle,  no  other  infection  or  contagion  can  act  as  a  cause  or 
as  one  cause  of  abortion.  If  the  B.  abortus  of  Bang  is  the 
cause  of  contagious  or  infectious  abortion  of  cattle,  then  the 
statement  of  McFadyean  and  Stockman,  that  in  one  preg- 
nant cow  which  they  destroyed  they  found  uterine  tubercu- 
losis which  would  soon  have  caused  abortion  without  the 
presence  of  B.  abortus,  is  erroneous.  If  B.  abortus  is  the 
cause,  B.  tuberculosis  can  not  be  a  cause  of  abortion.  But 
that  is  resting  the  case  upon  what  some  may  designate  a 
technicality.  More  pertinent  to  the  discussion  is  the  state- 
ment of  McFadyean  and  Stockman :  "It  is  of  great  im- 
portance to  note,  however,  that  two  natural  outbreaks  of 
vibrionic  abortion,  one  in  Ireland  and  one  in  Wales,  were 
met  in  cows."  (Abortion  in  Sheep,  Part  III,  page  9.)  The 
more  recent  finding  by  Theobald  Smith,  in  this  country,  of 
spirilla  in  aborted  bovine  fetuses,  without  the  B.  abortus,  is 
equally  to  the  point.  If  B.  abortus  is  the  cause  of  contag- 
ious, infectious,  or  epizootic  abortion  in  cattle,  then  either 
the  vibrio  of  McFadyean  and  Stockman  and  the  spirillum  of 
Smith  did  not  cause  the  abortions  attributed  thereto,  or  the 
abortions  so  caused  were  not  "infectious."  "contagious."  or 
"epizootic." 


Infections  of  the  Ovum,  Embryo  and  Fettis  513 

The  second  group,  to  which  the  writer  belongs,  holds  that 
abortion  is  not  a  specific  contagious  or  infectious  disease 
like  glanders  or  hog  cholera,  but  that  any  infection  resident 
in  the  cervical  end  of  the  uterus,  or  which  during  pregnancy 
invades  the  uterus,  may,  amongst  other  results,  cause  abor- 
tion. According  to  this  view  there  are  two  essential  factors 
in  the  causation  of  abortion :  the  infection  must  destroy  the 
life  of  the  fetus  (asphyxia  or  inanition  due  to  placentitis, 
or  sepsis  due  to  bacterial  invasion  of  the  fetus) ,  and  must 
arouse  such  an  irritation  of  the  uterus  (localized  metritis 
at  the  cervical  end)  as  to  cause  it  to  contract  and  expel  its 
contents.  Any  infection  capable  of  bringing  about  these 
two  conditions  may  cause  abortion,  be  it  the  B.  abortus,  the 
bacillus  of  Nocard,  the  colon  organism  of  Moussu,  the  vibrio 
of  McFadyean  and  Stockman,  or  the  spirillum  (vibrio)  of 
Theobald  Smith. 

Under  this  conception,  there  is  no  limitation  upon  the 
number  of  species  of  microparasites  which  may  cause  abor- 
tion, no  restrictions  upon  the  variety  of  lesions  and  results 
of  lesions  which  the  infection  may  cause,  and  no  obligatory 
period  of  invasion  or  disappearance  fixed  for  the  infection. 

This  conception  offers  many  analogies  to  wound  infection. 
In  wound  infection  there  is  an  extended  variety  of  organ- 
ism's, each  capable  of  producing  inflammation,  suppuration, 
ulceration,  necrosis,  wound  fever,  etc.  The  microorganisms 
are  normally  present  upon  the  body  surface  and  under  or- 
dinary conditions  cause  no  visible  harm  to  the  individual. 
When,  however,  the  protective  epithelium  is  destroyed  by 
physical  violence,  chemical  irritation,  or  in  various  ways, 
the  bacteria  upon  the  surface  are  pushed  into,  or  otherwise 
enter  the  damaged  tissues  and  wound  infection  occurs.  The 
lesion  which  constitutes  the  avenue  of  infection  may  be  visi- 
ble or  invisible  to  the  unaided  eye.  The  epithelium  may  be 
destroyed  or  merely  so  damaged  that  it  wants  the  power  re- 
quired to  resist  the  attack. 

A  knowledge  of  the  identity  of  the  invading  organisms  is 
of  great  interest  but  not  a  vital  necessity  to  the  surgeon. 
The  measures  which  will  exclude  streptococci  will  serve  also 
33 


514  Diseases  of  the  Genital  Organs 

to  bar  staphylococci.  If  the  wound  is  already  infected,  the 
surgeon  uses  the  same  means  to  remove  or  to  destroy  micro- 
cocci and  bacilli.  In  special  cases  the  surgeon  may  fear 
tetanus  infection  and  take  special  measures  against  it,  but 
that  he  classifies  separately  as  a  specific  infectious  disease. 
Each  individual  carries  upon  his  body  surface  bacteria  com- 
mon to  other  individuals.  A  moderately  extensive  list  can 
be  made  of  the  most  prevalent  types  competent  to  cause 
wound  infection. 

In  every  part  of  the  genital  tract  microorganisms  are  com- 
mon throughout  the  life  of  the  individual.  When  estrum 
occurs,  the  genital  mucosa  is  engorged  and  its  epithelium 
weakened.  If  conception  fails,  menstruation  follows,  with 
denudation  of  the  placental  areas  and  an  outflow  of  blood. 
The  denuded  areas  furnish  an  avenue  of  invasion  and  the 
blood  clots  supply  nutritive  material  for  the  bacteria  pres- 
ent. Should  conception  occur,  and  the  fertilized  ovum  de- 
scend into  the  uterus,  it  encounters  the  microorganisms  in- 
festing the  cavity.  The  embryo  has  acquired  no  power  to 
resist  invasion,  with  the  result  that  bacterial  activity  is  ad- 
vanced. Then  follows  a  definite  metritis.  As  soon  as  the 
fetal  organs  have  developed,  the  infection  passes  through 
the  chorion  and  amnion  into  the  amniotic  fluid  and  is  swal- 
lowed by  the  fetus.  Accordingly  the  bacteriologic  findings  of 
Hagan,  Carpenter,  and  others  working  in,  or  in  collabora- 
tion with  this  department,  show  parallel  infection  in  the 
non-gravid  uterus,  in  the  utero-chorionic  cavity  of  the  preg- 
nant uterus,  and  in  the  fetal  alimentary  tract,  and  later 
when  the  calf  is  born  the  same  bacteria  are  recoverable 
from  its  stomach  and  intestines.  There  is  then  a  continuity 
of  infection  in  the  mother  and  the  intra-uterine  invasion  of 
the  fetus. 

The  results  of  the  infection  or  infections  upon  the  mother, 
fetus,  and  new-born  calf  will  logically  vary  with  their  vol- 
ume and  virulence.  If  very  severe  in  the  non-pregnant 
uterus,  conception  fails.  If  the  infection  is  milder  and  con- 
ception occurs,  metritis  may  follow  and  so  irritate  the 
uterus  that  it  contracts  and  expels  its  contents.     If  the  in- 


Infections  of  the  Ovum,  Embryo  and  Fetus  515 

fection  has  killed  the  fetus,  and  it  is  expelled,  the  result  is 
known  as  abortion.  If  the  fetus  lives  and  is  carried  the  full 
term  of  gestation  and  is  then  expelled,  there  is  metritis  pres- 
ent and  perhaps  retained  afterbirth.  The  expulsion  of  the 
fetus  leaves  a  denuded  uterus.  If  the  afterbirth  is  retained, 
it  is  immediately  necrotic  and  decomposes.  Then  follows 
an  aggravated  metritis.  It  is  not  a  new  disease,  but  a  con- 
tinuation of  a  metritis  which  existed  during  pregnancy,  ac-. 
celerated  in  its  course  by  the  uterine  denudation  of  calving 
or  abortion,  aggravated  by  decomposing  afterbirth.  The 
infected  calf  when  born  may  break  down  with  calf  scours 
or  pneumonia.  It  is  not  usually  a  new  disease  or  a  new  in- 
fection but  the  continuation  of  an  infection  acquired  during 
intra-uterine  life.  During  the  course  of  the  dysentery,  the 
alimentary  epithelium  is  damaged  or  destroyed,  permitting 
the  invasion  of  the  body  fluids  by  the  bacteria  causing  the 
intestinal  disease.  If  the  calf  suffers  from  pneumonia,  the 
pulmonary  epithelium  is  damaged  or  destroyed  and  bacterial 
invasion  occurs.  The  infection  had  its  habitat  in  the 
pregnant  uterus,  and  thence  passed  to  the  digestive  tract  of 
the  fetus.  In  the  new-born  calf  apparently  the  infection 
passes  through  the  damaged  digestive  or  pulmonary  epi- 
thelium, enters  the  body  fluids,  and,  having  an  affinity  for 
the  genital  tract,  regains  its  habitat  there  and  persists,  to 
interfere  later  with  first  pregnancy.  According  to  this  con- 
ception, the  infections  of  which  abortion  is  one  significant 
result  constitute  an  endless  chain.  They  may  be  intensified 
in  the  uterus  of  the  cow  just  after  parturition  or  abortion 
and  additional  infections  from  the  exterior  be  added.  The 
infection  in  the  new-born  calf  may  be  minimized  or  intensi- 
fied by  proper  or  improper  feeding,  or  additional  infection 
may  be  supplied  to  the  calf  by  association  with  badly  dis- 
eased calves  or  by  taking  milk  contaminated  by  virulent 
discharges  from  badly  diseased  cows. 

On  the  other  hand,  the  belief  that  abortion  is  a  specific 
disease  denies  the  endless  infection-chain  above  described 
and  regards  sterility,  retained  afterbirth,  calf  scours,  and 
pneumonia  as  associated  or  concurrent  diseases,  but  recog- 


5i6  Diseases  of  the  Genital  Organs 

nizes  no  identity,  continuity,  or  causal  relationship.  Each 
must  then  be  handled  separately  as  distinct  maladies,  in- 
stead of  dealing  with  the  entire  list  as  one  group,  each  hav- 
ing a  continuity  with  the  others. 

As  in  wound  infection,  so  in  the  infections  in  which  abor- 
tion occurs,  while  no  limit  can  be  placed  upon  the  number  of 
microparasites  which  may  act  as  the  causal  agent,  certain 
varieties  are  commonest.  Thus  in  abortion,  in  one  area,  the 
B.  abortus  may  be  the  predominant  cause;  in  another,  a 
streptococcus ;  and,  in  a  third,  a  spirillum.  In  a  given  ani- 
mal or  outbreak,  B.  abortus  may  be  the  cause,  but  in  abor- 
tion generally  it  is  merely  a  cause.  Some  believers  in  the 
specific  character  of  abortion,  when  forced  by  recorded 
facts  to  admit  that  abortion  may  be,  and  is,  due  to  various 
organisms,  attempt  to  evade  the  difficulty  by  proposing  the 
name  "abortion  disease"  or  "Bang's  disease"  instead  of  the 
equally  misleading  terms  of  "contagious,"  "infectious,"  or 
"epizootic"  abortion.  But  that  does  not  help  matters.  It  is 
still  desirable  to  learn  how  large  a  part  of  the  abortions  are 
evidently  due  to  the  B.  abortus,  and  how  much  to  other  or- 
ganisms. 

The  second  conception  of  the  nature  of  abortion  permits 
the  handling  of  the  group  of  infections  as  a  whole.  The 
losses  can  be  minimized  only  by  breaking  or  weakening  the 
endless  chain  of  infection  at  its  most  vulnerable  point, 
which,  it  is  held,  is  at  the  commencement  of  the  life  of  the 
individual.  It  has  been  advised  that  the  genital  organs  of 
both  sexes  should  be  as  clean  as  practicable  at  the  time  of 
copulation  in  order  to  favor  conception.  When  fertilization 
has  occurred,  it  is  important  that  the  uterine  cavity  be  clean, 
so  that  metritis  and  infection  of  the  fetus  may  be  avoided. 
When  the  calf  is  born  it  should  be  so  handled  that  the  infec- 
tion it  may  have  acquired  in  the  uterus  shall  be  restrained 
or  eliminated,  and  that  no  fresh  infection  shall  menace  the 
calf  through  contaminated  milk  or  other  foods,  or  by  inti- 
mate association  with  badly  diseased  calves.  For  example, 
the  veterinarian  handling  cervicitis  sees  before  him  unmis- 
takable and  severe  inflammation  due  to  some  form  or  forms 


hifecHons  of  the  Ovum,  Embryo  and  Fetus  517 

of  infection.  No  matter  what  the  identity  of  the  infection 
may  be,  the  problem  which  he  faces  is  disinfection,  and  he 
elects  that  method  which,  in  the  present  state  of  knowledge, 
promises  the  best  results. 

G.     Symptoms  and  Diagnosis 

The  symptoms  and  diagnosis  of  abortion  are  essentially 
included  in  the  definition  given — the  observed  expulsion  of 
a  fetal  cadaver.  The  symptoms  are  those  of  parturition  ab- 
breviated. In  early  pregnancy  there  is  no  sinking  of  pelvic 
ligaments,  no  enlargement  of  mammae,  no  marked  dis- 
charge from  the  vulva,  no  visible  effort  at  expulsion.  When 
abortion  occurs  late  in  pregnancy,  the  pelvic  ligaments  may 
sink  as  in  parturition,  the  mammary  gland  may  be  en- 
larged and  the  vulva  may  become  tumefied.  But  any  of 
these  phenomena  may  occur  from  other  causes. 

After  about  the  fifth  month  of  pregnancy,  in  addition  to 
the  observation  of  the  expulsion  of  the  fetal  cadaver,  there 
may  be  retention  of  the  fetal  membranes,  indicating  that 
abortion  has  occurred  or  that  abortion  is  then  in  course. 

Abortion  may  be  suspected  or  determined  with  confidence 
upon  other  grounds.  In  the  regular  control  of  reproduc- 
tion in  cattle,  pregnancy  may  be  reliably  diagnosed  at 
thirty  to  sixty  days  after  coitus.  If  the  diagnosis  is  clear 
and  definite,  as  it  should  ordinarily  be,  and  it  is  later  de- 
termined that  the  pregnancy  has  ceased  to  exist  and  the  ani- 
mal has  not  calved,  it  is  clear  she  has  aborted  at  some  time 
between  the  two  dates  of  observation. 

The  diagnosis  of  pregnancy  may  be  fairly  secure  upon 
other  grounds  than  clinical  examination.  If  a  cow  or 
heifer  is  regular  in  her  estrual  cycle,  is  bred,  does  not  men- 
struate after  coitus,  and  estrum  fails  to  recur  at  the  regular 
interval,  it  is  good  evidence  that  she  is  pregnant.  If,  after 
a  lapse  of  forty  to  ninety  or  one  hundred  days,  estrum  re- 
curs, it  is  probable  that  an  embryo  has  perished  and  has 
been  expelled.  There  are  numerous  other  conditions  which 
may  present  the  same  history,  but  abortion  is  by  far  the 
most  probable  explanation. 


5i8  Diseases  of  the  Genital  Organs 

H.  The  Date  of  Invasion 
The  infection  which  causes  abortion  invades  the  uterus 
prior  to  the  establishment  of  the  uterine  seal.  The  ortho- 
dox believers  in  a  specific  contagious  abortion  have  stoutly 
contended  that  the  infection  commonly  invades  the  uterus, 
fetal  membranes  and  fetus  after  pregnancy  has  become  es- 
tablished, the  placenta  has  formed  and  the  cervical  canal 
has  become  hermetically  sealed.  As  already  related,  they 
have  attempted  to  prove,  and  believe  they  have  proven 
their  contention  by  experimentally  causing  abortion  in  an 
existing  pregnancy.  In  the  cov^,  as  discussed  in  preceding 
pages,  the  experimenters  have  kept  no  checks  or  controls 
and  their  experimental  inoculations  have  been  followed  by 
no  higher  rate  of  abortion  than  is  commonly  observed  in 
uninoculated  animals.  They  have  further  attempted  to 
prove  that  a  pregnancy  already  established  can  be  inter- 
rupted by  artificial  infection  of  pregnant  animals  of  other 
species.  But,  as  with  cows,  no  control  animals  have  been 
kept.  The  rate  of  abortion  following  inoculation  has  not 
been  remarkably  higher  than  common  in  the  species  used, 
and  there  is  no  evidence  that  an  equally  high  ratio  of  abor- 
tion would  not  have  followed  the  injection  of  a  sterile,  inoc- 
cuous  substance.  It  is  a  perfectly  well  known  clinical  fact 
that  the  various  species  of  domestic  animals  commonly  co- 
habit on  farms.  Horses,  cattle,  swine,  dogs  and  cats  are 
in  intimate  contact,  but  cohabitation  fails  utterly  to  cause 
the  spread  of  abortion  from  one  species  to  another.  If 
abortion  were  spread  by  the  means  alleged  by  the  believers 
in  "contagious  abortion"  such  as  the  eating  by  pregnant 
animals  of  food  which  has  become  contaminated  by  the  dis- 
charges from  an  aborter,  by  the  infection  carried  upon  the 
boots,  hands  and  so  forth  of  attendants,  or  by  the  mere 
presence  of  an  abortion,  an  abort,  or  the  afterbirth  of  an 
abort  in  a  stable  or  a  field,  an  outbreak  of  abortion  in  one 
species  would  be  the  signal  for  many  pregnant  animals  of 
whatever  species  to  abort.  The  recorded  evidence  of  the 
transmission  of  "contagious  abortion"  of  cows  to  all  species 


Infectio7is  of  the  Ovum,  Embryo  and  Fetus  519 

of  domestic  animals  should,  before  it  is  accepted  as  proof, 
be  supplemented  by  a  new  and  extensive  series  of  experi- 
ments with  adequate  control  animals.  Until  this  is  done, 
the  controversy  over  the  date  of  invasion  of  the  infection 
causing  abortion  can  not  be  satisfactorily  settled. 

I  have  held  that  there  are  two  notable  and  important 
dates  of  invasion — the  intra-uterine  infection  of  the  fetus 
and  the  time  of  coitus  in  adults.  The  latter  has  already  been 
consdered  earlier  in  this  chapter  (I — Infections  of  the  Geni- 
tal Organs  of  Bulls).  The  first  will  be  considered  later  (III 
— The  Congenital  Infections  of  Calves). 

I.     The  Control  of  Abortion 

Under  the  views  already  expressed,  abortion  can  not  be 
directly  prevented  or  controlled,  nor  is  there  need  for  such 
prevention  or  control.  Being  neither  a  disease  nor  a  symp- 
tom of  any  one  infection,  it  demands  no  separate  considera- 
tion. It  can  be  prevented  only  by  the  control  of  the  infec- 
tions within  the  genitalia  of  both  sexes.  These  are  consid- 
ered elsewhere. 

When  abortion  came  to  be  looked  upon  as  a  specific  con- 
tagious disease,  veterinarians  and  cattle  breeders  hoped  for 
a  definite  remedy.  Before  it  was  believed  that  the  cause  of 
abortion  had  been  determined,  Brauer  (1889)  thought  he 
had  discovered  a  specific  remedy  in  the  subcutaneous  injec- 
tion of  2  per  cent,  carbolic  acid  to  pregnant  cows  and  heifers. 
Highly  favorable  statistics  were  submitted  by  Brauer  and 
his  followers  in  support  of  the  new  remedy.  The  researches 
were  without  controls  and  very  inaccurate.  Apparently  the 
carbolic  acid  was  given  in  herds  where  there  had  recently 
been  an  "abortion  storm,"  in  which  a  notable  decrease  was 
to  be  expected,  or,  as  occurs  frequently,  a  few  animals  had 
aborted,  all  or  nearly  all  of  those  which  were  in  line  to  abort, 
and  then  the  remedy  was  given.  Naturally  there  would  be 
no  more  abortions.  But  the  career  of  the  alleged  cure  was 
short  and  it  was  soon  found  that  if  the  utero-chorionic 
space  of  a  pregnant  cow  was  highly  infected  and  contained 


520  Diseases  of  the  (renital  Organs 

a  large  volume  of  exudate,  she  would  probably  abort,  and 
that  carbolic  acid,  hypodermically  or  otherwise,  exerted  no 
recognizable  influence. 

The  belief  of  Bang  and  his  followers  that  he  had  discov- 
ered the  specific  cause  of  abortion  immediately  aroused  high 
hopes  that  a  definite  remedy  would  follow.  It  was  believed 
by  Bang  that  the  discovery  of  the  cause  would  be  followed 
quickly  by  a  cure  or  by  some  means  for  control.  The  vast 
majority  of  investigators  and  breeders  have  concentrated 
their  efforts  since  1896  upon  finding  a  remedy  for  abortion, 
based  upon  B.  abortus  as  the  specific  cause.  There  has  been 
no  more  lamentable  failure  in  the  annals  of  veterinary  medi- 
cine than  the  attempt  to  control  abortion  as  a  specific  con- 
tagious disease  due  to  the  B.  abortus  of  Bang.  The  infec- 
tions in  the  genital  tract  of  cattle  have  increased  enormously 
in  virulence  in  every  country.  In  America  numerous  herds 
of  pedigreed  cattle  of  potentially  great  value  do  little  more 
than  maintain  their  numerical  status.  Death  and  disability 
from  genital  diseases  of  females  of  breeding  age  consume 
practically  all  heifer  calves  reared  in  the  herd.  The  sur- 
plus bull  calves  carry  into  the  herds  where  they  are  sold 
virulent  infections  with  which  they  are  saturated  at  birth. 
Despite  this  evident,  pitiably  disastrous  failure,  many  in- 
vestigators, veterinarians  and  breeders  are  clinging  tena- 
ciously to  the  belief  that  abortion  in  cattle  is  a  specific  con- 
tagious disease  due  to  the  B.  abortus  and  that  its  control  is 
to  be  brought  about  upon  that  basis  and  that  alone. 

After  the  failure  of  the  Brauer  plan  with  carbolic  acid. 
Rich  of  Vermont  believed  for  a  time  that  he  had  discovered 
an  efficient  systemic  disinfectant  in  methylene  blue,  but  the 
error  was  promptly  recognized  and  the  plan  abandoned. 

Attempts  to  disinfect  the  contents  of  the  pregnant  uterus 
are  contrary  to  all  existing  knowledge  of  its  physiology  and 
that  of  the  embryo.  Experiments  show  that  aniline  dyes, 
like  methylene  blue,  do  not  reach  the  embryo,  but  are  caught 
or  turned  back  at  the  placenta.  It  is  not  known  that  any 
disinfectant  can  pass  the  placental  filter  in  a  manner  to  ex- 
ert practical  influence.    In  abortion  most  of  the  infection  is 


Infections  of  the  Ovnm,  Embryo  and  Fetus  521 

in  the  utero-chorionic  space.  Into  this  space  it  is  not  known 
that  any  disinfectant  borne  in  the  blood  ever  enters.  It 
probably  does  not.  Even  should  a  disinfectant  leave  the 
blood  stream  and  enter  the  utero-chorionic  space,  it  is  in- 
conceivable that  sufficient  would  enter  to  disinfect.  The  en- 
dometrium of  a  pregnant  cow  at  full  term  represents  ap- 
proximately fifteen  square  feet  of  mucous  membrane,  op- 
posed to  which  is  the  somewhat  smaller  surface  of  the  con- 
tiguous chorion.  Between  the  two  there  exist,  in  badly  in- 
fected cows  as  revealed  in  the  abattoir,  from  a  few  ounces 
to  several  quarts  of  "abortion  exudate."  It  must  require 
great  confidence  in  the  potency  of  disinfectants  to  believe 
that  a  sufficient  quantity  can  enter  the  utero-chorionic  cavity 
to  disinfect  it,  or  pass  the  placental  filter  and,  after  coursing 
through  the  fetus,  be  poured  into  the  fetal  alimentary  canal 
and  disinfect  the  meconium.  The  employment  of  disinfec- 
tants in  this  apparently  hopeless  manner  has  been  virtually 
abandoned — permanently,  it  is  to  be  hoped. 

The  generally  accepted  theory  that  abortion  in  cattle  is  a 
specific  contagious  disease  led  many  of  the  subscribers  to 
that  belief  to  hope  for  a  specific  remedy  in  the  form  of  a 
serum,  bacterin,  vaccine,  or  other  biologic  substance.  Nota- 
ble achievements  in  this  field  had  been  made  in  a  number 
of  diseases  of  man  and  animals  and  it  was  assumed  that  in 
abortion  a  similar  victory  was  probable. 

The  achievements  in  the  biologic  control  of  disease  have 
been  chiefly  among  those  maladies  designated  as  acute,  in 
which  a  definite  immunity  follows  the  recovery  of  the  pa- 
tient. In  chronic  infections  little  progress  has  been  made 
in  biologic  therapy,  apparently  because  the  success  of  these 
products  is  dependent  upon  their  power  to  produce  that 
state  known  as  immunity.  Infectious  diseases  are  divisible 
primarily  into  acute  and  chronic.  In  acute  infectious  dis- 
eases the  infection  and  the  patient  can  not  long  coexist. 
Either  the  infection  kills  the  patient  or  there  develops  with- 
in the  body  of  the  patient  substances  which  destroy  the 
infection  and  which  thereafter  prevent,  for  a  variable  pe- 
riod, re-infection.    This  is  known  as  immunity.    In  chronic 


52  2  Diseases  of  the  Genital  Organs 

infections,  such  as  tuberculosis  and  syphilis,  the  patient 
may  survive  indefinitely  and  the  infection  continue  in  viable 
form.  The  system  of  the  patient  acquires  a  power  of  re- 
sistance to  the  ravages  of  the  infection,  but  not  the  power 
commonly  to  destroy  it  or  to  prevent  reinfection. 

Those  who  regard  the  B.  abortus  as  the  specific  cause  of 
abortion  in  cattle  hold  confused  views  as  to  whether  it  is 
acute  or  chronic.  Those  who  claim  to  have  induced  abortion 
experimentally,  constructively  hold  that  it  is  an  acute  in- 
fection. Some  believe  that  they  have  induced  abortion  in 
five  to  ten  days.  At  first  that  was  the  general  belief.  Bang 
in  his  first  experiments  believed  he  was  dealing  with  an 
acute  infection  having  a  short  incubation  period.  Experi- 
menters believing  in  the  specific  character  of  cattle  abor- 
tion generally  hold  that  it  is  an  acute  infection  for  guinea 
pigs :  that  is,  if  the  B.  abortus  is  injected  into  a  pregnant 
guinea  pig,  she  will  abort  in  five  to  ten  days.  Numerous  in- 
vestigators now  hold  that  the  B.  abortus  infection  is  virtu- 
ally an  acute  infection  in  the  uterus  and  a  chronic  infection 
in  the  mammary  glands.  That  is,  the  infection  can  not  in- 
vade the  uterus  until  pregnancy  is  definitely  established, 
and  can  not  continue  in  the  uterus  for  more  than  a  few 
days  after  the  termination  of  pregnancy.  They  further  hold 
that,  after  one  fetal  cadaver  has  been  expelled,  the  uterus 
acquires  an  immunity  and  the  B.  abortus  can  not  again 
readily  invade  it  and  cause  a  second  abortion,  but  the  mam- 
mary gland,  once  invaded,  is  permanently  infected.  Schroe- 
der  thinks  that  the  mammary  gland  is  the  permanent  hab- 
itat of  the  B.  abortus  and  periodically,  during  pregnancy, 
the  infection  may  in  part  pass  from  the  mammae  to  the 
uterus,  cause  abortion,  and  then  promptly  disappear  from 
the  uterus.  It  is  reasonably  well  established  that  the  B. 
abortus  may  be  a  permanent  resident  of  the  milk  glands. 
So  far  as  I  have  seen  recorded,  it  has  not  been  searched  for 
elsewhere  than  in  the  genital  canal  and  milk  glands.  One 
cow  in  my  experimental  herd,  now  ten  years  old,  was  inocu- 
lated in  the  jugular  in  her  first  pregnancy  at  about  seven- 
teen months  of  age.     She  was  probably  already  infected 


hifedions  of  the  Oinim,  Embryo  and  Fetus 


523 


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524  Diseases  of  the  Genital  Organs 

when  I  inoculated  her.  Her  blood  still  showed  a  high  de- 
gree of  infection  when  she  was  eight  years  old.  Clinically 
she  has  a  high  degree  of  genital  infection  as  shown  by  a  very 
low  rate  of  reproduction.  It  appears  clear,  therefore,  that 
those  who  hope  to  control  or  eradicate  abortion  through  the 
agency  of  biologic  methods  must  hope  for  an  artificial  im- 
munity in  a  chronic  infection. 

There  is  a  common  belief  in  a  natural  immunity  against 
abortion.  That  is,  it  is  stated  that  after  a  cow  has  aborted 
once,  she  is  not  so  liable  to  abort  again.  The  assertion  has 
been  made  and  remade  so  often  and  persistently  that  by 
mere  repetition  it  has  virtually  acquired  the  force  of  a 
fact.  But  it  is  perverted  fact.  The  influence  of  abortion 
upon  future  reproduction  is  well  shown  in  Fig.  175.  In 
this  instance  eighteen  apparently  vigorous  heifers  received 
abortion  bacterins  in  their  first  pregnancies  in  order  to  test 
experimentally  the  power  of  killed  bacteria  to  prevent  abor- 
tion. The  heifers  in  this  herd  had  for  some  years  averaged 
about  30  per  cent,  of  observed  abortions.  The  heifers  shown 
upon  the  chart  had  been  handled,  except  for  the  bacterins, 
the  same  as  prior  heifers.  As  calves  they  had  been  grown 
in  an  abominable  "nursery"  under  pest-house  conditions. 
Dysentery  and  pneumonia  had  been  virtually  universal.  The 
mortality  of  calves  had  been  high,  but  the  survivors  recov- 
ered their  general  health  and  were  apparently  perfectly 
sound.  Yet  this  group  of  vigorous  heifers  failed  to  main- 
tain its  original  numbers  of  fertile  females.  The  losses  from 
infections  within  the  genital  tract  were  so  great  that  the 
female  progeny  failed  utterly  to  fill  the  gaps  made  by  dis- 
ease. If  abortion  produces  a  valuable  immunity  against  fu- 
ture abortions,  this  group  of  heifers  should  have  acquired 
such  immunity  and  have  produced,  during  the  period  cov- 
ered by  the  chart,  a  notable  excess  of  healthy  females  in- 
stead oi  the  discouraging  deficit  so  clearly  shown. 

It  is  perfectly  true  that  many  aborting  heifers  and  cows 
do  not  repeat  the  abortion  the  following  year,  or,  if  re- 
peated, it  is  not  recorded.  When  an  ordinary  grade  cow  is 
observed  to  expel  a  fetal  cadaver,  she  has  usually  reached 


Infections  of  the  Ovum,  Embryo  and  Fetus  525 

the  fifth  to  eighth  month  of  pregnancy.  Prior  to  concep- 
tion, probably  three  to  six  months  had  elapsed  since  the 
previous  calving.  She  is  consequently  nearly  or  completely 
dry  and  the  owner  cannot  hope  for  profitable  lactation  or 
for  a  healthy  calf  until  about  twelve  more  months  have 
elapsed.  Naturally  she  is  sold  for  beef,  or  disappears  for 
some  other  reason.  This  is  well  illustrated  in  the  work  of 
BlandS  who  states  that  in  the  herds  listed  in  1914-1916,  to- 
talling 1,016  animals,  there  had  been,  in  1919,  305  or 
30  per  cent,  of  abortions.  In  the  same  herds,  in  1914- 
1916,  160  animals  are  accounted  for  which  had  aborted  in 
1913;  145,  or  48  per  cent.,  of  those  aborting  in  1913  were 
not  in  the  herds  in  1914.  Probably  some  died,  some  were 
sterile  and  therefore  sold,  and  some  may  have  conceived 
and  have  been  sold  to  other  dairymen  hut  not  because  the 
seller  thought  them  imrnune  to  abortion.  Of  the  160  cows 
aborting  in  1913  which  are  reported  in  1914-1916,  107,  or 
67  per  cent.,  calved  and  33  per  cent,  failed  to  produce  calves 
during  the  period  of  two  or  three  years  between  1913  and 
1916.  Though  they  were  presumably  the  most  promising 
of  the  aborters  in  1913,  33  per  cent,  failed  to  produce  calves. 
These  data  fail  to  show  a  valuable  immunity. 

Infections  of  the  genital  tract,  like  chronic  infections  of 
other  organs,  are  rarely  static.  During  the  interval  between 
weaning  (or  changing  from  a  milk  to  a  vegetable  diet)  and 
the  first  coitus,  the  animal  enjoys  the  most  healthful  period 
of  its  life,  judged  by  clinical  standards.  When  sex  activity 
begins,  it  is  difficult  to  conceive  of  a  static  condition  of  the 
bacteria  in  the  genital  tract.  Abortion  signifies  one  grade 
of  activity  of  these  bacteria,  lower  in  virulence  than  sterility 
and  higher  than  dysentery  and  retained  fetal  membranes. 
It  should  not  be  expected  that  in  each  breeding  year  an 
active,  virile  infection  would  maintain  throughout  a  given 
level  but  that  it  would  vacillate  from  year  to  year.  Should 
the  intensity  increase  markedly,  causing  hydrosalpinx,  pyo- 
salpinx,  or  ordinary  salpingitis,  the  animal  becomes  seri- 

1  Bland,  G.  R.,  Second  Rep.  Ag.  Organizer,  Epizootic  Abortion  Exp., 
1911-1916,  Oxfordshire,  Eng.,  page  15. 


526  Diseases  of  the  Genital  Organs 

ously  or  hopelessly  sterile  and  her  breeding  career  is  closed. 
This  alone  renders  it  impossible  for  many  aborters  to  abort 
again  the  following  year.  But  the  cow  may  improve,  the 
uterus  gain  new  vigor,  and  the  infection  become  largely  re- 
pressed. Then,  if  she  aborts  at  all,  it  will  be  later  in  her 
pregnancy.  If  the  repression  of  the  infection  goes  further, 
pregnancy  may  continue  to  full  term  and  a  live  calf  be  born. 
The  cow  may  have  retained  fetal  membranes  and  the  calf 
may  have  dysentery,  but  abortion,  as  defined,  is  absent. 
The  same  or  a  kindred  infection,  however,  is  still  present 
and  active.  Naturally,  therefore,  the  infection  in  the  geni- 
tal tract  does  not  as  a  rule  bring  about  each  year  precisely 
the  same  result,  except  when  hopeless  sterility  has  been 
reached. 

In  all  data  I  have  been  able  to  obtain,  it  has  been  shown 
clearly  that  a  given  number  of  cows  or  heifers  which 
aborted  the  previous  year  are  more  likely  to  abort  again  the 
next  year  than  an  equal  number  of  animals  which  have 
dropped  healthy  calves.  But  the  question  is  to  be  decided 
by  the  percentage  of  abortions  among  those  which  become 
pregnant.  A  far  larger  proportion  of  the  aborters  fail  to 
breed.  The  difference  between  the  two  classes  is  rendered 
more  clear  when  the  false  measure  of  abortion  is  discarded 
and  the  results  are  measured  by  the  percentage  of  healthy 
calves  born. 

Regardless  of  the  foregoing  facts,  it  is  attempted  to  con- 
trol or  eradicate  abortion,  working  upon  the  theory  that  it 
is  a  specific  contagious  disease  and  that  one  attack  produces 
a  distinct  and  valuable  immunity. 

B.  abortus  serum  has  been  proposed  as  a  remedy  and  has 
failed.  I  used  serum  experimentally  upon  a  group  of  26 
heifers'  without  result  upon  abortion,  sterility  or  other  in- 
terference with  reproduction.  The  animals  upon  which  the 
serum  was  used  aborted  at  virtually  the  same  rate  as  the 
controls  and  the  two  groups  aborted  at  the  average  rate  for 
the  herd  in  which  the  abortion  rate  had  for  years  been  vir- 
tually static.    My  results  were  in  harmony  with  all  available 

'All.  Rf]).  N.  Y.  State  Vet.  Col.,  1916-1917. 


Infections  of  the  Ovum,  Embryo,  and  Fetus  527 

recorded  experiences.  A  few  biologic  vendors  offer  abor- 
tion serum,  but  it  has  attained  no  popularity.  There  is  no 
reason  to  assume  that  such  a  serum  can  produce  favorable 
results. 

Abortion  hacterins  (killed  cultures  of  B.  abortus)  have 
been  tried  by  Bang,  McFadyean  and  Stockman,  and  other 
leading  investigators.  In  all  recorded  tests  they  have  failed 
utterly.  The  phenomenon  of  abortion  lends  itself  readily  to 
patent  medicme  methods.  If  at  the  close  of  an  abortion 
storm  abortion  bacterins  or  distilled  water  be  injected  sub- 
cutaneously,  the  abortion  ceases  or  the  rate  is  very  low. 
The  eighteen  heifers  charted  in  Fig.  175  were  in  a  herd 
where  for  a  number  of  years  the  abortion  rate  in  heifers 
varied  from  30  per  cent,  to  50  per  cent,  or  upward.  After 
the  use  of  the  bacterins  the  abortion  rate  was  the  most  dis- 
astrous in  the  history  of  the  herd.  In  spite  of  the  clear  and 
indisputable  proofs  recorded  of  the  absolute  uselessness  of 
abortion  bacterins,  several  American  biologic  houses  make 
and  sell  them  under  wholly  unjustifiable  claims.  Some  even 
offer  to  refund  the  sum  paid  for  the  preparation  for  each 
cow  that  aborts  after  the  administration.  This  is  perfectly 
feasible,  since  so  far  as  manufacturing  costs  are  concerned 
the  vendor  can  refund  upon  50  to  75  per  cent,  of  the  animals 
and  have  a  good  profit.  Some  abortion  bacterins  are  very 
cheaply  made.  I  submitted  a  number  of  samples  purchased 
upon  the  open  market  to  bacteriologists  for  examination. 
Nearly  all  were  greatly  contaminated  with  other  bacteria, 
usually  a  mixture  of  three,  four  or  more  kinds.  One  sample 
consisted  of  an  almost  pure  growth  of  a  long  streptococcus. 
As  the  bacteria  were  presumably  dead,  the  species  probably 
made  no  difference. 

Abortion  vaccines,  or  living  cultures  of  B.  abortus,  given 
non-pregnant  animals  one  or  two  months  prior  to  breeding 
have  been  tried  by  numerous  leading  experimenters  and 
have  been  recommended  by  some.  Sir  Stewart  Stockman, 
with  a  group  of  lay  collaborators,  has  been  the  chief  sup- 
porter of  this  plan.     Stockman^  apparently  conducted  no 

1  Sir  Stewart  Stockman,  Epizootic  Abortion,  Rep.  loth  Internat.  Vet. 
Congress. 


^28  Diseases  of  the  Genital  Organs 

researches  personally,  but  states :  "a  local  organization  was 
set  up  in  each  case  consisting  of  members  of  farmers'  so- 
cieties and  veterinarians,"  to  whom  the  details  of  the  work 
and  the  reports  were  entrusted.  In  the  data  published  by 
Stockman,  it  is  not  shown  upon  what  plan  the  herds  inves- 
tigated were  divided  into  "inoculated"  and  "controls."  It 
is  quite  easy,  if  one  is  acquainted  with  the  history  of  each 
animal,  to  change  the  face  of  statistics  materially.  Stock- 
man rests  his  statistics  upon  the  percentage  of  abortions 
and  ignores  reproduction.  He  takes  it  for  granted  appar- 
ently that  if  a  cow  does  not  abort,  or  rather  is  not  observed 
to  abort,  nothing  else  in  her  career  is  of  interest.  Thus,  in 
his  table  IX  comprising  758  animals,  77.6  per  cent,  of  vac- 
cinated animals  and  70.2  per  cent,  of  the  controls  calved. 
The  efficiency  of  the  controls  fell  7.4  per  cent,  below  the 
vaccinated.  The  efficiency  was  low  in  both.  The  weakest 
point  in  the  data  of  Stockman  is  the  failure  to  state  the 
time  covered  by  the  experiments.  If  77.6  per  cent,  of  the 
vaccinated  cattle  calved  during  one  year  and  were  fertile  at 
the  close  of  the  year,  the  performance  was  certainly  better 
than  if  the  period  extended  over  two  or  three  years,  because 
the  efficiency,  if  the  standard  is  set  at  one  calf  per  annum, 
would  be  77.6  per  cent.,  38.8  per  cent.,  and  25.9  per  cent,  re- 
spectively. 

The  Bland  reports'  offer  by  far  the  most  valuable  data  on 
record  for  a  critical  study  of  the  influence  of  the  vaccina- 
tion of  non-pregnant  cows  with  living  cultures  of  B.  abortus. 
The  first  report  is  stated  to  cover  experiments  during  1911- 
1913.  At  what  date  in  1911  the  researches  began  is  not  re- 
vealed, nor  is  it  stated  when  in  1913  they  closed.  Since  the 
second  report  is  stated  to  apply  to  1914-1916,  there  was  pre- 
sumably no  interval  between  the  two  reports.  In  the  1911- 
1913  report  it  is  claimed  that  of  263  animals  vaccinated.  226 
(86  per  cent.)  calved.  There  is  no  intimation  that  during 
1911-1913  any  cow  calved  twice  or  thrice.  If  the  observa- 
tions cover  two  years,  the  annual  reproduction  rate  is  43 

'Bland,  G.   R.,  Ivpi/.oolic    Abortion    Experiments,    Oxfonlsliirc   L\>nnty 
Council:  First  Report,  1911-1913;  Second,  1914-1916. 


Infections  of  the  Ovum,  Embryo    and  Fetns 


529 


per  cent,  of  the  ideal  of  one  calf  each  twelve  months.  Dur- 
ing the  same  period  the  reproduction  in  the  controls  was 
77.4  per  cent.,  or  only  8.6  lower  than  in  the  vaccinated.  In- 
advertently selecting  the  controls  improperly  might  very 
well  have  made  a  much  greater  difference. 

Bland  compares  the  abortion  rate  in  1910  with  the  rate 
upon  the  same  premises  in  1911-1913,  but  the  cattle  in  the 
herds  of  1910  were  not  the  same  as  those  used  in  the  experi- 
ments. In  effect,  he  says,  "In  1910  the  cow.  Rose,  aborted 
(100  per  cent,  abortion)  and  in  1911-1914  the  cow,  Cherry, 
was  vaccinated  and  calved  (100  per  cent,  calves)  ;  therefore 
vaccination  reduced  the  abortion  rate  from  100  per  cent,  to 


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Fig.  176 — Chart  of  Agglutination  Test  on  Three  Heifers  after  Inocu- 
lation with  B.  abortus  with  failure  to  read  on  date  of  Abortion. 


zero."  That  is,  Bland  asserts  that  in  1910,  28.9  per  cent,  of 
671  animals,  or  194,  aborted,  and  later  he  states  that  66  of 
the  1910  aborters  were  used  in  the  1911-1913  experiments, 
and  128  aborters  disappeared.  Forty-three  cows  which 
aborted  in  1910  were  vaccinated  in  1911-1914,  and  of  these 
29  (67  per  cent.)  calved.  Evidently  the  dairymen  selected 
for  holding  those  aborters  which  gave  the  greatest  promise 
34 


530  Diseases  of  the  Geniial  Otgaiis 

of  breeding.  It  is  not  disclosed  whether  it  took  on  an  aver- 
age one,  two,  or  three  years  for  one  of  the  aborters  to  pro- 
duce ia  calf. 

The  unreliable  character  of  Bland's  experiments  is  further 
indicated  by  the  fact  that,  while  the  announced  plan  was  to 
vaccinate  only  non-pregnant  animals,  he  actually  did  not 
know  whether  they  were  pregnant  or  not.  As  a  conse- 
quence a  number  of  pregnant  heifers  and  cows  were  inocu- 
lated. Although  B.  abortus  was  looked  upon  as  tJie  cause  of 
abortion  and  would  quite  certainly  cause  abortion  if  injected 
during  pregnancy  for  that  purpose,  the  animals  erroneously 
inoculated  to  prevent  abortion  were  benefited  the  same  as 
the  non-pregnant  animals. 

In  such  experiments  dairymen  sooner  or  later  become 
good  practical  judges  of  results.  Before  the  1914-1916  re- 
searches began,  most  of  the  dairymen  owning  the  herds  of 
the  1911-1913  experiments  had  dropped  the  work;  before 
the  close  of  1916  a  majority  of  the  animals  in  the  second  set 
of  experiments  had  been  withdrawn. 

In  defiance  of  these  and  all  other  recorded  data,  several 
American  firms  make  and  sell  what  they  represent  as  abor- 
tion vaccines  consisting  of  living  B.  abortus  cultures.  Bac- 
teriologists to  whom  I  submitted  samples  purchased  in  the 
open  market  failed  by  cultural  method  to  find  living  abortion 
bacteria  in  any  sample.  There  is  probably  no  alleged  thera- 
peutic substance  upon  the  market,  biologic  or  proprietary, 
which  is  advertised  in  a  more  misleading  and  unjustified 
manner.  There  is  absolutely  no  justification,  so  far  as  I 
can  find  recorded,  for  the  claim  that  abortion  can  be  econo- 
mically decreased  by  their  use.  The  data  of  Bland  appear 
on  the  surface  to  decrease  the  abortion,  but  the  abortion  rate 
is  largely  a  matter  of  vision.  The  number  of  calves  was  not 
materially  increased  in  the  Bland  experiments,  since  the 
abortions  were  statistically  lowered  by  the  higher  rate  of 
sterility. 

I  believe  abortion  vaccines  (if  they  really  contain  living 
abortion  bacilli)  the  most  dangerous  and  vicious  biologic 
product  thus  far  offered  to  veterinarians  and  stockmen.    It 


Infediojis  of  the  Ovnm,  Embryo  and  Fetus  531 

is  perfectly  well  known  that  the  B.  abortus  is  a  permanent 
resident  of  the  mammary  gland.  It  is  not  known  that  it  is 
not  a  permanent  dweller  in  other  parts,  once  introduced. 
Although  experimentally  it  has  not  been  shown  clearly  that 
B.  abortus  does  or  can  invade  the  pregnant  cow  and  cause 
abortion  there  is  good  evidence  that  it  is  a  dangerous  infec- 
tion in  the  genital  tracts  of  cattle  and  that  in  the  present 
state  of  our  knowledge  attempts  to  use  it  as  a  therapeutic 
agent  are  little  short  of  criminal.  Researches  may  throw  a 
more  favorable  light  upon  vaccination,  but  until  they  do  the 
prudent  veterinarian  and  dairyman  should  leave  this  work 
where  it  belongs — in  the  hands  of  experimenters. 

Upon  the  theory  that  the  observed  expulsion  of  a  fetal 
cadaver  is  a  specific  contagious  disease,  it  is  repeatedly  pro- 
posed to  control  abortion  by  quarantine  restrictions  asso- 
ciated with  disinfection  of  the  aborter  and  of  the  premises 
occupied  by  her.  Public  funds  are  expended  in  researches 
upon  "contagious  abortion,"  and  the  public  demands  a  visi- 
ble return  upon  the  investment.  As  a  consequence  the 
United  States  Department  of  Agriculture,  through  its  Bu- 
reau of  Animal  Industry,  and  the  agricultural  experiment 
stations  of  the  various  states  are  expected  to  advise  dairy- 
men and  breeders  how  to  control  losses  from  "contagious 
abortion."  Not  only  do  laymen  who  are  suffering  economic 
losses  demand  a  remedy,  but  they  expect  measures  which 
the  ordinary  dairyman  or  breeder  can  successfully  apply. 
The  result  is  that  much  advice  is  given  without  visible  bene- 
fit. The  owner  is  advised  to  quarantine  all  aborters,  but 
probably  he  sees  less  than  one  out  of  three  fetal  cadavers 
which  are  expelled.  Yet  inferentially  he  is  taught  to  believe 
that  those  which  he  does  not  see  do  not  matter  and  that 
quarantining  the  known  aborters  will  eliminate  the  danger 
from  the  far  greater  number  of  unseen  expulsions  of  fetal 
cadavers.  The  abortion  is  not  the  disease.  Once  the  fetal 
cadaver  and  its  membranes  are  expelled,  that  danger  ends. 
The  cause  of  the  expulsion  of  the  dead  fetus,  the  metritis 
and  cervicitis,  continues  indefinitely  and  quarantine  does 
not  affect  it  in  the  least.     Precisely  the  same  infections 


532  Diseases  of  the  Genital  Organs 

which  caused  the  abortion  existed  long  prior  to  the  final  dis- 
aster, and  they  continue  indefinitely  afterward.  Quarantine 
does  not  annul  the  peril  prior  to  abortion,  nor  does  it  render 
the  animal  safe  after  the  common  duration  of  quarantine 
has  expired.  Some  of  these  advisers  direct  that  an  aborter 
shall  be  quarantined  until  all  discharge  ceases,  but  no 
definition  of  "discharge"  is  given.  Long  after  a  cow 
has  aborted  and  all  signs  of  discharge,  as  commonly  ac- 
cepted, have  ceased,  the  cervical  canal  or  uterine  cavity  may, 
and  often  does,  contain  a  few  drops,  or  quarts,  or  gallons  of 
pus.  The  cow  with  a  few  quarts  of  pus  in  her  uterus  is  a 
safer  animal  in  a  herd  than  one  without  visible  or  notable 
discharge  but  which  has  in  the  uterus  or  cervical  canal  a  few 
drops  of  virulent  pus  associated  with  inflammation  of  the 
uterine  or  cervical  mucosa.  The  cow  with  large  volumes  of 
pus  which  is  being  discharged  does  not  generally  come  in 
estrum.  In  the  dairy  the  pus  chiefly  drops  into  the  gutter 
and  disappears.  Some  of  it  reaches  the  milk,  but  not  as 
much  when  the  cow  is  in  the  herd  as  when  she  is  in  quaran- 
tine, because  in  the  latter  state  she  is  neglected. 

The  cow  with  a  few  drops  of  pus  in  the  uterus  or  cervix 
ovulates  and  copulates.  Coitus  intensifies  the  disease  in  her 
genital  tract  and  endangers  the  genital  health  of  the  bull. 
Such  a  cow  either  fails  to  conceive  or  conceives  only  after 
repeated  copulations,  with  undue  sex  strain  and  infection 
dangers  to  both  cow  and  bull.  If  she  conceives,  the  infec- 
tion in  the  cervical  canal  or  uterus  leads  to  the  death  of  the 
embryo  or  fetus ;  or  the  pregnancy  continues  to,  or  near  to 
full  term,  a  sick  calf  is  born,  and  the  cow  has  metritis,  often 
associated  with  retained  fetal  membranes.  Ordinary  quar- 
antine— the  isolation  of  aborters  from  pregnant  cows — 
neither  adds  security  to  nor  hastens  recovery  from  the  me- 
tritis and  cervicitis,  but  the  layman,  ignorant  of  the  nature 
of  the  disease,  is  misled  into  the  assumption  that  quarantine 
has  therapeutic  value.  As  a  matter  of  fact  quarantine,  as 
ordinarily  conducted  with  aborting  cows,  is  a  therapeutic 
vice.  The  cows  are  denied  the  food,  housing  and  care  con- 
ducive to  the  spontaneous  recovery  or  amelioration  of  dis- 


Infections  of  the  Ovum,  Embryo  and  Fetus  533 

ease.  I  have  yet  to  see  quarantined  cows  receive  that  atten- 
tion and  care  which  is  accorded  the  presumably  well  animals. 

The  effect  of  the  quarantine  of  aborters  upon  the  re- 
mainder of  the  herd  is  nil.  The  removal  of  an  aborter  after 
the  act,  or  while  it  is  in  course,  does  not  eliminate  or  modify 
any  possible  injury  from  the  unobserved  discharges  which 
have  occurred  days,  weeks,  or  months  preceding  the  expul- 
sion of  the  fetus.  More  important  still,  the  quarantine  of 
an  aborter  can  not  possibly  cure  or  ameliorate  the  infection 
which  exists  in  the  uterus  or  cervix  of  another  pregnant  cow 
or  heifer. 

In  the  quarantine  scheme  commonly  advised,  there  is  in- 
cluded only  a  minority  of  animals  in  which  the  embryo  or 
fetus  dies  and  is  expelled.  Up  to  the  fourth  or  fifth  month 
of  pregnancy  in  dairy  cattle,  the  expulsion  of  the  embryonic 
or  fetal  cadaver  is  not  observed.  In  beef  cattle,  especially 
those  in  extensive  pastures,  the  observation  is  far  less  ac- 
curate. While  the  expulsion  of  fetal  cadavers  is  doubtless 
less  frequent  in  beef  than  in  dairy  cows,  it  is  equally  certain 
that  the  apparent  difference  is  due  partly  to  a  difference  in 
the  accuracy  of  observation. 

The  quarantine  of  aborters  can  not  lessen  the  dangers 
from  those  intensely  infected  animals  which  do  not  abort. 
When  metritis  exists  during  pregnancy,  it  necessarily  con- 
tinues after  parturition,  frequently  with  retained  fetal  mem- 
branes. The  volume  of  highly  infectious  material,  identical 
with  the  discharges  following  abortion,  is  usually  far  greater 
than  that  associated  with  abortion,  but  the  quarantine 
scheme  generally  recommended  ignores  these.  Finally, 
many  cows  which  drop  apparently  healthy  calves  and  are 
to  outward  appearances  perfectly  well,  when  professionally 
examined  sixty,  ninety  or  more  days  post  partum,  show  an 
intense  cervicitis  with  a  few  drops  of  pus  in  the  cervical 
canal  and  in  the  cervical  end  of  the  uterine  cavity.  Noth- 
ing but  harm  can  come  from  attempting  to  breed  such  cows, 
but  quarantine,  as  commonly  advised  for  aborters,  has  no 
influence  whatever  upon  these  animals.  I  have  examined 
herds  where  the  abortions  recorded  did  not  exceed  15  per 


534  Diseases  of  the  denifal  Organs 

cent.,  but  60  per  cent,  showed  intense  pyo-cervicitis  and 
were  sterile.  The  quarantine  of  the  15  per  cent,  of  aborters 
could  cure  the  cervicitis  neither  in  these  nor  in  the  45  per 
cent,  of  cows  having  cervicitis  which  had  not  aborted. 
Quarantine  could  not  influence  favorably  either  the  quaran- 
tined or  the  remainder  of  the  herd  from  which  the  aborters 
were  removed.  Clinically  the  scheme  for  controlling  abor- 
tion by  the  quarantine  of  aborters  has  failed  completely. 
It  has  been  the  common  measure  applied  throughout  the 
civilized  world  for  more  than  fifty  years,  a  period  during 
which  the  virulence  of  the  infections  of  the  genital  organs 
and  the  economic  losses  sustained  have  increased  enor- 
mously. The  quarantine  of  aborters  has  been  attempted  by 
the  most  intelligent,  earnest  and  competent  dairymen  and 
breeders,  whose  losses  have  been,  if  anything,  greater — 
certainly  no  less — than  the  losses  in  the  herds  of  the  most 
careless  and  ignorant.  Although  quarantine  of  aborters 
has  been  conscientiously  and  faithfully  applied  to  many 
herds  since  the  theory  of  specific  disease  became  established, 
no  record  is  extant,  so  far  as  I  am  aware,  where  the  quar- 
antine of  aborters  has  favorably  influenced  reproduction. 
If  failure  in  practice  is  competent  argument  against  a  the- 
ory, then  the  theory  that  abortion  is  a  specific  contagious 
disease  of  cattle,  and  that  quarantine  based  upon  that  the- 
ory is  a  valuable  sanitary  measure,  falls  to  the  ground. 

Some  of  the  devotees  to  the  theory  of  the  specific  charac- 
ter of  abortion  have  recently  turned  to  another  quarantine 
scheme  consisting  of  the  diagnosis  of  the  alleged  specific  in- 
fection by  the  agglutination  and  complement-fixation  tests 
of  the  blood  of  each  animal  in  a  herd.  Quite  naturally  they 
have  advised  that,  in  assembling  herds  and  in  making  addi- 
tions thereto,  these  tests  should  be  applied  to  all  purchases. 
It  has  already  been  pointed  out  that  the  line  of  demarcation 
between  infected  and  non-infected,  as  indicated  by  these 
tests,  has  been  fixed  by  absolutely  arbitrary  means  and  that 
the  agglutination  and  complement-fixing  power  of  the  blood 
from  infected  and  non-infected  animals  is  absolutely  un- 
known.   Even  if  it  were  admitted  that  abortion  in  cattle  is  a 


Infections  of  the  Ovum,  Embryo    and  Fet^is  535 

specific  disease  due  to  B.  abortus,  there  are  ample  reasons 
for  believing  that  the  blood  of  animals  free  from  the  infec- 
tion of  B.  abortus  does  not  react  at  all  to  these  tests  at  the 
lowest  point  where  they  can  be  applied.  It  is  further  evi- 
dent that  the  tests  fail  at  high  dilutions  when  the  infection 
is  abundant.  This  defect  is  well  illustrated  in  Fig.  176,  in 
which  the  agglutination  test  was  negative  upon  the  day  of 
abortion.  Two  prominent  advocates  of  the  serologic  tests 
for  the  control  of  abortion,  jointly  published  a  bulletin  in 
1918  in  which  they  said :  "The  serological  tests  are  an  im- 
portant aid  in  the  inauguration  of  preventive  measures 
against  the  spread  of  infectious  abortion."  Throughout  the 
publication,  the  serologic  tests  appear  as  the  corner  stone 
in  control  measures.  They  advised  the  test  as  a  means  for 
isolating  the  infected  from  the  non-infected  animals  and  for 
preventing  the  introduction  of  the  infection  in  purchased 
cattle  of  both  sexes.  In  1919  they  had  modified  their  views 
and  in  a  second  bulletin  advocated  the  disinfection  of  the 
copulatory  organs  of  the  bull  as  the  most  important  meas- 
ure of  control  available,  and  say:  "Our  work  of  the 
past  five  years  has  convinced  us  that  transmission  by 
the  male  is  by  far  the  most  important  means  of  spread- 
ing the  disease Proper  disinfection  of  the 

sheath,  therefore,  constitutes  the  most,  if  not  the  only,  im- 
portant safeguard  against  the  spread  of  infectious  abor- 
tion." The  italics  are  mine.  They  present  no  data  to 
show  that  they  accomplished  any  actual  improvement  either 
under  the  repudiated  first  plan  or  under  the  second  recom- 
mendation. 

Another  important  group  of  believers  that  abortion  is  a 
specific  contagious  disease  advocate  the  quarantine  of  abor- 
ters,  plus  the  disinfection  of  aborting  cows,  of  the  external 
genitalia  of  breeding  bulls,  and  of  the  premises  occupied  by 
aborters.  There  appeared  an  undated  circular  from  one  of 
these  sources  with  a  title  page  printed  chiefly  in  red  which 
reads  in  part,  "Fight  Contagious  Abortion  in  Cattle 
.  .  .  Preventable — Controllable  .  .  .  Isolate  af- 
fected   animals — Treat    aborting    cows — Disinfect    bulls — 


536  Diseases  of  the  Genital  Organs 

Clean  up  premises."  It  was  held  in  the  circular  that  if 
breeders  and  dairymen  generally  would  conscientiously  and 
vigorously  apply  the  advice  contained  in  a  bulletin  soon  to 
appear,  "contagious  abortion"  would  be  eliminated  or  con- 
trolled. 

In  1917  there  appeared  from  the  same  source  a  bulle- 
tin which  was  apparently  an  amplification  of  the  pre- 
ceding circular.  Among  other  recommendations  the  bul- 
letin advises  that  the  aborter  be  isolated  and  that  her 
uterus  be  irrigated  daily  with  antiseptics.  "Lugol's  so- 
lution in  a  strength  of  2  per  cent,  has  been  found  to 
be  desirable  as  a  uterine  douche.  It  is  not  permitted 
to  remain  in  the  uterus  but  is  flushed  out  with  salt  so- 
lution." The  bulletin  was,  of  course,  designed  for,  and  sent 
to,  laymen  who  do  not  know  the  uterus  from  the  vagina, 
cervix,  or  oviducts.  If  the  afterbirth  is  retained,  neither 
the  layman  nor  the  skilled  veterinarian  can  possibly  douche 
the  uterus,  because  it  is  everywhere  covered  by  the  chorion. 
If  the  afterbirth  has  come  away  from  the  aborter,  the  entire 
endometrium  is  denuded  of  epithelium.  The  introduction 
of  2  per  cent.  Lugol's  solution  into  such  a  uterus  is  a  pro- 
fessional crime.  It  will  kill  or  ruin  sexually  a  large  propor- 
tion of  cows,  and  injure  all.  Fortunately  most  laymen  in- 
troduce antiseptics  into  the  vagina  only,  from  which  they 
are  sometimes  ejected  before  material  harm  has  resulted. 
I  have  had  an  opportunity  to  study  a  group  of  27  aborters, 
purebred  beef  cattle  of  great  value,  to  which  a  layman  had 
attempted  to  apply  these  recommendations.  Of  the  27  ani- 
mals, 12  (44.4  per  cent.)  have  atresia  of  the  vagina,  unques- 
tionably due  to  the  treatment.  Two  of  these  twelve  (16.7  per 
cent.)  are  again  pregnant  after  about  one  year.  Each  has  a 
severely  constricted  vagina  and  will  apparently  have  great, 
if  not  insuperable  difficulties  at  calving  time.  Six  of  the  re- 
maining animals  may  possibly  (but  very  improbably)  con- 
ceive, with  the  probability  that  they  cannot  calve  success- 
fully. The  other  four  of  the  twelve  are  hopeless  because  of 
the  vaginal  atresia  and  must  go  to  slaughter.  In  two  of  the 
four  the  vaginal  atresia  is  so  complete  that   mucus  is  re- 


Infections  of  the  Ovum,  Embryo  and  Fetus  537 

taineci  in  front  of  the  atretic  area,  causing  great  disten- 
sion. Of  the  fifteen  animals  in  this  group  in  which  vaginal 
atresia  was  not  caused,  six  (40  per  cent.)  are  pregnant,  one 
possibly  pregnant,  and  eight  (53  per  cent.)  non-pregnant, 
with  fair  prospects  for  conceiving.  The  instance  affords  a 
good  illustration  of  the  results  attained  from  erroneous  ad- 
vice given  to  laymen  who,  however  intelligent  and  sincere, 
fail  in  their  application. 

Advising  laym-en  how  to  handle  surgically  a  cow  which 
has  recently  aborted  is  much  like  a  Doctor  of  Medicine  ad- 
vising a  carpenter  how  to  diagnose  and  handle  appendicitis 
in  a  member  of  his  family,  with  the  saws,  chisels,  and  other 
implements  at  hand.  The  owners  of  cattle  view  the  prob- 
lem from  another  angle.  Certain  veterinarians  are  sup- 
ported by  public  funds,  and  stockowners  feel  they  have  a 
right  to  demand  of  these  public  servants  advice  regarding 
abortion.  These  veterinarians  have  for  so  long  taught  the 
public  to  believe  in  abortion  as  a  specific  infectious  disease 
that  they  can  give  no  advice  of  value  without  clashing  vio- 
lently with  the  thoroughly  established  misconception. 

There  is  nothing  known  at  present  beyond  general  good 
care  which  can  in  the  least  exert  favorable  influence  upon 
an  infection  already  existing  in  the  utero-chorionic  space  of 
a  pregnant  heifer  or  cow.  After  abortion  has  occurred  and 
the  uterus,  cervix,  and  vagina  are  open  to  surgical  invasion, 
the  skilled  veterinarian  can  do  much  to  cleanse  the  genital 
tract  of  injurious  infections.  The  good  which  may  be  ac- 
complished at  that  time  is  not  based  upon  the  theory  that 
abortion  is  a  specific  infectious  disease,  but  that  all  abor- 
tions are  due  to  an  infection  or  to  the  joint  action  of  several 
infections.  At  present  the  known  remedies  against  abortion 
are  alike  eff"ective  in  all  infections  which  may  lead  to  the 
death  of  the  fetus  and  its  expulsion  by  the  uterus.  The 
handling  of  the  infections  of  the  genital  canal  calls  for  the 
application  of  the  general  principles  of  surgery.  Those 
cases  of  cervicitis  and  metritis  existing  during  pregnancy 
and  inevitably  continuing  after  abortion  call  for  the  same 
method  of  handling  as  those  not  associated  with  abortion 


538  Diseases  of  the  Genital  Organs 

but  dependent  upon  the  presence  of  the  same  infection.  The 
handling  of  such  infections  is  discussed  in  the  appropriate 
places. 

4.    Puerperal  Diseases  of  the  Uterus 

When  pregnancy  terminates,  those  infections  which  have 
been  present  in  the  utero-chorionic  space  of  the  gravid 
uterus  meet  with  abrupt  changes  in  environment  which  may 
profoundly  alter  their  activity.  New  forms  of  bacteria  may 
also  quite  readily  invade  the  uterus  at  this  period.  If  a  calf 
is  born  or  a  fetal  cadaver  is  expelled  and  the  fetal  mem- 
branes follow  promptly,  the  entire  placental  area  of  the 
uterus  is  denuded  of  its  epithelium  and  the  tissues  laid  open 
to  attack.  The  infections  present  in  the  utero-chorionic 
space  have  already  invaded  the  placental  tissues  about  the 
cotyledonal  periphery  and  are  ready  to  advance  rapidly 
when  epithelial  denudation  becomes  genejal.  If,  instead  of 
being  expelled,  the  fetus  dies  and  macerates,  the  fetal  cada- 
ver acts  as  a  vast  nutrient  reservoir  for  bacteria  which  mul- 
tiply in  it  and  profoundly  involve  the  contiguous  uterus.  If 
a  calf  is  born  or  a  fetal  cadaver  is  expelled,  and  the  fetal 
membranes  are  retained,  the  latter  are  necrotic  and,  like 
the  retained  fetal  cadaver,  serve  as  a  great  nutrient  supply 
for  infections  present.  The  dilation  of  the  cervical  canal, 
vagina,  and  vulva  permits  a  greater  supply  of  air  in  the 
uterine  cavity,  which  may  modify  favorably  or  unfavorably 
the  activities  of  the  bacteria. 

It  was  long  believed,  and  quite  generally  taught,  that  the 
infections  imperilling  the  life  or  health  of  the  puerperal  fe- 
male regularly  invade  the  uterus  after  the  close  of  preg- 
nancy. In  an  important  measure  that  is  true,  but  by  far 
the  most  important  infections,  measured  by  their  frequency 
and  economic  bearing,  are  those  which  are  resident  within 
the  pregnant  uterus  and  acquire  increased  intensity  when 
pregnancy  terminates.  The  infections  of  the  puerperal 
uterus  are  consequently  divisible  into  two  great  groups — 
the  intrinsic  or  intra-uterine  infections  continuing  from 
pregnancy,  and  the  extrinsic  organisms  invading  the  uterus 
from  without  after  pregnancy  has  terminated. 


Puerperal  Diseases  of  the  Uterus  539 

A.  Uterine  Hemorrhage.  Uterine  Hematoma. 
Hemorrhage  into  the  uterus  of  the  cow  during  the  puer- 
perium  is  of  two  distinct  classes.  An  insignificant  hemor- 
rhage regularly  follows  the  prompt  dehiscence  of  the  fetal 
membranes.  Lacerations,  especially  of  the  cotyledons,  fre- 
quently cause  slight  hemorrhage.  Hemorrhage  is  also 
caused  by  imprudent  attempts  at  removing  retained  fetal 
membranes.  These  forms  are  to  be  handled  according  to 
the  general  rules  of  surgery. 

Clinically  the  most  interesting  and  most  important  type  of 
uterine  hemorrhage  is  that  which  is  apparently  one  of  the 
results  of  intra-uterine  infection.  The  hemorrhage  appears 
without  warning  soon  after,  but  not  immediately  following 
parturition.  I  have  observed  it  at  two  to  four  days  post 
partum.  My  cases  have  occurred  in  cows  in  intensely  in- 
fected herds.  As  I  recall,  each  patient  had  given  birth  to  a 
calf,  but  the  parturition  was  tardy,  testifying  to  the  pres- 
ence of  a  uterine  paresis  due  to  a  metritis  of  pregnancy. 
The  fetal  membranes  were  not  long  retained  and  the  pa- 
tients were  apparently  going  along  favorably,  when  sud- 
denly without  warning  a  very  profuse  uterine  hemorrhage 
began.  One  of  my  cases  had  been  left  at  night  in  a  box 
stall,  apparently  well.  When  the  caretaker  arrived  in  the 
morning,  the  cow  was  weak  from  loss  of  blood  and  her  stall 
looked  like  shambles.  Bright  scarlet  blood  was  spattered 
over  the  walls  and  bedding,  and  blood  was  still  trickling 
from  her  vulva.  A  few  hours  later  I  found  upon  examina- 
tion, as  nearly  as  I  could  estimate,  a  blood  clot  in  the  uterus 
equal  to  two  or  three  gallons.  The  blood  was  coagulated, 
odorless,  and  bright  scarlet  in  color.  Fearing  recurrence, 
I  proceeded  to  remove  with  great  care  a  portion  of  the  clot 
each  day,  until  in  three  days  I  had  completely  evacuated  the 
uterus.  It  maintained  throughout  its  bright  scarlet  color. 
It  underwent  no  visible  decomposition  and  acquired  no  spe- 
cific odor.  The  cow  recovered  and  was  fertile.  In  a  second 
case  a  colleague  removed  the  blood  from  the  uterine  cavity, 
first  controlling  the  hemorrhage  by  the  use  of  adrenalin 
chloride  hypodermically. 


540  Diseases  of  the  Genital  Organs 

Uterine  hemorrhage  of  the  puerperium  apparently  bears 
an  interesting  relationship  to  other  uterine  hemorrhages  in 
the  cow.  Elsewhere  interplacental  hemorrhages  from  the 
pregnant  uterus  with  fetal  desiccation  have  been  described. 
Presumably  in  that  case  infection  plays  the  essential  part. 
At  any  rate  it  is  observed  chiefly  in  cattle  belonging  to 
highly  infected  herds.  Unfortunately  the  initial  stages  of 
interplacental  hemorrhage  in  the  pregnant  cow  are  not 
available  for  observation.  The  desiccation  of  the  fetus  is 
ordinarily  the  first  step  recognized.  In  fetal  desiccation, 
as  in  puerperal  hemorrhage,  there  is  no  observed  tendency 
to  putrefaction.  Apparently  it  has  been  thought  that  fetal 
desiccation  occurs  because  the  cervix  remains  closed  and 
sealed  so  that  bacteria  may  not  invade  the  hematoma,  fetal 
membranes,  and  fetal  cadaver.  That  is  evidently  incorrect. 
Bang  and  others  have  recognized  the  B.  abortus  in  the  desic- 
cated fetus.  That  bacterium  possesses  scant  putrefactive 
power.  In  the  uterine  hemorrhages  under  consideration 
there  seems  to  be  something  more  than  a  neutral  force  at 
work.  When  the  hemorrhage  commences,  the  uterine  cavity 
is  freely  open  to  the  exterior  and  is  certainly  heavily  in- 
fected. The  escaped  blood,  instead  of  forming  a  breeding 
ground  for  commonly  known  bacteria  which  set  up  putre- 
faction, possesses  a  unique  power  to  prevent  putrefaction. 
An  ordinary  blood  clot  in  the  uterus  or  in  a  wound  is  the 
signal  for  the  intensification  of  infection  in  the  part,  but 
here  the  opposite  occurs.  The  first  suggestion  of  its  unique 
character  comes  with  the  blood  escaping  from  the  vulva, 
which  is  intensely  scarlet,  much  brighter  than  ordinary  ar- 
terial blood,  and  looks  much  like  blood  from  the  lungs. 

An  interesting  fact,  also,  is  that  the  uterine  hematoma  of 
the  puerperal  period,  if  left  to  itself,  apparently  desiccates 
in  a  manner  similar  to  the  desiccation  of  the  fetus.  At  least 
there  are  sometimes  found  in  the  uterus  old  desiccated  blood 
clots.  I  have  observed  a  number  of  these  in  the  abattoir, 
usually  involving  one  uterine  horn  only  (the  hemorrhage 
having  occurred  in  the  gravid  cornu  alone?),  but  sometimes 
chiefly  in  the  uterine  body  and  projecting  into  one  horn.    In 


Puerperal  Diseases  of  the  Uieriis 


541 


Fig.  177 — Old  Hematoma  of  Right  Uterine  Horn. 

a,  Viewed  from  above.     /,   Hematoma  ;    2,  left   coriiu  apparently  healthy 

J,  section  through  left  ovary  showing  corpus  luteuni. 

b.  Ventral   surface.     4,    longitudinal  section   through   righi   horn  ;  5,  cros 


section  through  right  horn,  showing  hematoma 
through  normal  left  horn. 


6,  section 


542 


Diseases  of  the  Geyiital  Organs 


one  instance  one  horn  contained  a  desiccated  hematoma  and 
the  other  an  apparently  healthy  embryo  three  or  four  inches 
long.  The  plan  of  the  hematoma  is  well  illustrated  in  Fig. 
177,  in  which  the  right  cornu  is  completely  filled  by  the  old 
blood  clot,  while  the  left  horn  remains  normal  and  vacant. 
The  only  interpretation  which  I  can  place  upon  the  condi- 
tion is  that,  at  the  termination  of  the  last  pregnancy,  there 
occurred  within  a  few  days  a  voluminous  hemorrhage  into 
the  gravid  horn.  Part  of  the  blood  escaped  through  the 
cervix  and  vagina  to  the  exterior,  and  part  remained  behind 
to  undergo  desiccation  and  to  continue,  like  the  better  known 
desiccated  fetus,  embedded  in  the  hematoma,  as  an  inert 
body  which  may  persist  for  months  and  years.  The  desic- 
cated hematoma  is  a  firm,  doughy,  black,  tarry  mass.  When 
the  fresh  specimen  is  incised,  it  is  so  sticky  that  it  is  diffi- 
cult to  push  a  knife  through  it  merely  because  of  its  adhe- 
siveness. Parts  of  the  mass  adhere  to  the  knife  and  are 
exceedingly  difficult  to  wash  away.     It  is  virtually  insoluble 


Fio.  178— Tesselated  Hematoma  in  Right  Uterine  Horn. 

V,  Vaj^ina  ;    U,  uterine  body  ;    T'',  l]\  /  ",  uterine  horn  ;   ( ',  ovary 

/,  /,  /,  Hard  tesselated  niasst-s  closely  parked  totji-ther. 


Puerperal  Diseases  of  the  Uterus  543 

in  water.  There  is  a  total  absence  of  odor  beyond  that  of 
meat.  There  is  no  reaction  of  the  endometrium.  The  desic- 
cated blood  adheres  to  it  as  closely  as  to  the  knife  or  to  the 
operator's  hands.  The  cervical  canal  is  unsealed,  except  in 
the  co-existence  of  pregnancy. 

It  appears  that  with  age  further  changes  may  occur,  the 
desiccation  proceed  further,  and  finally  the  hematoma  be- 
come fragile  and,  fracturing  in  places  owing  to  visceral 
movements,  become  tesselated  in  contour,  as  shown  in  Fig. 
178.  However,  it  still  retains  its  resistance  to  putrefaction 
and  no  fetor  appears. 

As  a  rule  foreign  bodies  lying  within  the  uterus  inhibit 
estrum  and  ovulation.  I  have  had  no  opportunity  to  study 
the  uterine  hematoma  clinically,  but  in  my  collection  there 
is  one  example  where  a  hematoma  occupies  one  horn  and  an 
apparently  healthy  embryo  the  other.  This  seems  to  me 
conclusive  proof  that  uterine  hematoma  does  not  always 
inhibit  ovulation.  As  I  interpret  the  specimen,  the  hemor- 
rhage into  one  horn,  occurring  shortly  after  the  close  of  a 
prior  pregnancy,  did  not  permanently  fill  the  cavity  of  the 
uterine  body,  and  the  cervical  canal  did  not  become  sealed. 
The  presence  of  the  hematoma  did  not  inhibit  estrum  and 
ovulation,  and  the  way  was  left  open  for  conception.  I  sus- 
pect that  this  case  is  an  exception  to  the  rule  and  that  gen- 
erally the  hematoma  inhibits  estrum  and  ovulation. 

The  diagnosis  of  the  type  of  uterine  hemorrhage  here  de- 
scribed appears  to  be  comparatively  simple.  The  cow  calves 
in  a  manner  to  attract  no  special  notice.  From  the  condi- 
tions which  existed  in  the  two  herds  where  I  observed  it, 
the  infection  of  the  genitalia  is  intense,  and  logically  the 
parturition  atonic  and  tardy.  The  fetal  membranes  pre- 
sumably come  away  without  material  delay.  As  I  under- 
stand the  condition,  placentitis  of  that  type  causing  placen- 
tal incarceration  is  incompatible  with  this  type  of  hemor- 
rhage. I  believe  that  the  hemorrhage,  as  in  menstruation, 
and  in  the  inter-placental  hemorrhage  with  fetal  desiccation, 
comes  wholly  from  the  cotyledons,  so  that  any  placentitis 
of  a  type  causing  stasis  and  thrombosis  in  the  placental  ves- 


544 


Diseases  of  the  Genital  Organs 


sels  would  prevent  the  escape  of  blood  in  the  manner  de- 
scribed. The  first  clinical  evidence  of  the  hemorrhage  is 
the  escape  from  the  vulva  of  large  volumes  of  an  unusually 
bright  scarlet  blood  without  history  of  traumatic  injury. 
The  cow  is  generally  uneasy  (the  cramps  of  severe  hemor- 
rhage?) and  moves  about  restlessly,  occasionally  lying  down 
and  getting  up.  The  bright  scarlet  blood  escaping  from  the 
vulva  stains  the  bedding,  walls,  and  any  object  with  which 
the  posterior  parts  of  the  cow  may  come  in  contact.  De- 
pending upon  the  degree  of  hemorrhage,  there  is  weakness. 
An  examination  of  the  uterus  reveals  a  great  hematoma  fill- 
ing the  recently  gravid  horn.  The  clot  is  moderately  firm. 
The  treatment  should  consist  at  first  of  eff"orts  to  control 
the  hemorrhage.  With  the  very  limited  knowledge  possessed, 
I  would  counsel  leaving  the  clot  alone  for  a  time  and  would 
limit  efforts  at  control  to  the  hypodermic  administration  of 
adrenalin  chlorid  in  doses  of  one-fourth  to  one-half  ounce 
of  the  1-1000  solution.  It  should  be  repeated  at  intervals 
of  one-half  to  one  hour  if  the  case  demands.  Efforts  should 
be  made  to  keep  the  patient  quiet. 

Once  the  hemorrhage  has  ceased,  the  removal  of  the  clot 
should  be  undertaken  with  the  hope  of  obviating  three  possi- 
ble dangers:  (1)  If  the  hematoma  is  removed  too  early,  the 
manipulation  may  revive  the  hemorrhage.  (2)  If  permitted 
to  remain  for  several  days,  the  cervix  may  contract,  ren- 
dering the  removal  of  the  clot  very  difficult.  (3)  If  still 
further  neglected,  the  clot  becomes  desiccated,  exceedingly 
sticky,  virtually  insoluble,  can  not  be  suspended  in  water, 
and  can  not  readily,  by  any  known  method,  be  removed  by 
douching.  The  veterinarian  need  not  hasten  the  removal 
for  fear  of  putrefaction  of  the  clot  because,  so  far  as  known, 
it  possesses  properties  which  inhibit  purulent  destruction. 
The  closure  of  the  cervical  canal  sufiiciently  to  offer  great 
obstruction  to  the  insertion  of  the  hand  will  not,  as  a  rule, 
occur  until  two  or  three  days  have  elapsed  after  the  hemor- 
rhage. The  physiologic  uterus  closes  of  course  at  an  earlier 
date,  but  the  uterus  under  consideration  is  paretic.  Other- 
wise the  hemorrhage  would  not  have  occurred.    The  behav- 


Puerperal  Diseases  of  the  Uterus  545 

ior  of  the  cervix  should  be  watched  and  the  removal  of  the 
clot  attempted  sufficiently  early.  The  chief  mass  of  the  clot 
is  best  removed  by  carefully  breaking  it  down  with  the 
hand,  and  flushing  out  the  detached  pieces  with  physiologic 
salt  solution.  The  douching  should  be  done  with  the  great- 
est possible  gentleness,  preferably  by  means  of  a  hospital 
irrigator  to  which  is  attached  the  seven-foot  pure  rubber 
catheter  designed  for  douching  the  sheaths  of  bulls.  This 
catheter  is  soft  and  pliable,  and  can  not  readily  damage  the 
endometrium.  Its  small  calibre,  permitting  the  solution  to 
enter  the  uterus  slowly,  avoids  any  sudden  distension  of  the 
organ.  While  the  salt  solution  is  entering  the  uterus,  the 
operator  should  carefully  break  up  the  clot  with  his  fingers. 
After  the  clot  has  been  removed,  the  uterus  should  be 
watched  closely  for  untoward  developments. 

The  clinical  diagnosis  of  the  desiccated  hematoma  has  not 
fallen  to  my  lot.  Apparently  it  should  be  easy.  The  mass 
is  doughy  and  firm,  as  in  the  first  stages  of  fetal  desiccation. 
In  the  latter  case,  however,  the  fetus  is  usually  palpable, 
especially  its  head  or  the  feet,  some  of  which  may  lie  in 
close  proximity  to  the  uterine  wall.  Later  the  desiccated 
fetus  becomes  extremely  hard  and  its  skeletal  outlines  clear. 
The  cervical  canal  is  sealed  in  desiccated  fetus,  but  open  in 
desiccated  hematoma,  except,  as  in  one  instance  mentioned 
above,  when  a  hematoma  was  present  in  one  horn  and  an 
embryo  in  the  other.  One  may  meet  clinically  the  very  old 
tesselated  hematoma  of  Fig.  178.  It  is  almost  as  hard  as  a 
desiccated  fetus,  but  the  skeletal  outlines  of  the  mummy  are 
absent  and  the  hematoma  is  even  in  its  general  contour, 
with  the  small  depressions  where  the  clot  has  become  fis- 
sured. 

I  have  had  no  occasion  to  handle  the  desiccated  uterine 
hematoma  and  know  of  no  rule  upon  which  to  proceed. 
Evacuating  the  uterus  by  douching  is  well-nigh  hopeless, 
as  the  sticky  content  is  virtually  insoluble  in  water.  The 
dislodgment  of  the  corpus  luteum  gives  little  promise  be- 
cause, in  my  one  observation,  the  corpus  luteum  had  atro- 
phied in  order  to  permit  the  animal  to  ovulate  from  the  op- 
35 


546  Diseases  of  the  Genital  Organs 

posite  ovary  and  conceive.  Pituitary  extract  might  act 
favorably,  given  hypodermically  in  small  doses.  As  a  final 
resort  laparotomy  may  be  performed  upon  the  involved 
side,  the  affected  horn  lifted  out  and  incised,  and  the  clot 
mechanically  removed.  Or  one  may  amputate  the  involved 
horn  with  the  ovary  and  for  breeding  rely  upon  the  remain- 
ing horn. 

B.     Puerperal  Endometritis 

Puerperal  endometritis,  as  here  ufeed,  signifies  a  type  of 
metritis  in  which  the  endometrium  or  uterine  mucosa  is 
most  prominently  involved.  Infection  within  the  uterine 
cavity  presents  illimitable  variations  in  its  course  and  mani- 
festations, and  it  is  impossible  to  group  the  various  types  of 
puerperal  uterine  infections  so  that  each  class  shall  be 
clearly  and  definitely  separated  from  the  others.  It  is  es- 
sential that  the  variations  be  grouped  in  a  general  manner 
in  order  to  facilitate  description,  but  necessarily  some  cases 
will  be  met  upon  the  border  line  between  any  two  groups, 
which  may  with  equal  logic  be  placed  in  either  one.  Any 
given  case  may  also,  by  either  progression  or  retrogression, 
shift  from  one  group  to  another. 

The  efi'ect  of  intra-uterine  infection  is  not  limited  to  the 
endometrium.  Whenever  such  infection  is  activated  by  the 
disturbances  incident  to  the  termination  of  pregnancy  (just 
as  holds  true  of  intra-uterine  infection  during  pregnancy), 
the  changes  can  not  be  definitely  confined  to  the  endome- 
trium, but  involve  the  muscular  walls  of  the  organ,  caus- 
ing paresis,  and  frequently  also  involve  the  serosa.  Conse- 
quently the  term  "endometritis,"  if  taken  literally,  is  a  mis- 
nomer. It  may  be  said  to  be  the  simplest  and  most  primitive 
type  of  metritis.  Generally  speaking  it  is  out  of  endometri- 
tis that  the  more  severe  and  critical  forms  of  metritis  de- 
velop. Sometimes  the  metritis  of  pregnancy  has  passed  be- 
yond the  stage  designated  as  endometritis  before  pregnancy 
terminates,  sometimes  the  progress  of  the  infection  is  so 
rapid  that  no  stage  is  clinically  recognizable  as  endometritis. 

A  pregnant  heifer  or  cow  doomed  to  abort,  to  calve  pre- 
maturely, or  to  have  retention  of  the  fetal  membranes  has 
in  her  uterus  an  endometritis  which  inevitably  persists  into. 


Puerperal  Diseases  of  the  Uterus  547 

if  not  through  the  puerperal  period.  Even  more  commonly 
there  is  present  in  the  gravid  uterus  a  slight  endometritis 
which  does  not  reveal  itself  in  the  puerperal  animal  by  abor- 
tion, premature  birth,  or  retained  fetal  membranes,  but  may 
pass  unobserved  until  several  days  have  elapsed  after  par- 
turition, when  clinical  evidence  appears  in  the  form  of  an 
obvious  and  characteristic  genital  discharge.  In  many 
other  instances  the  exudate  in  the  uterus  is  not  visibly  dis- 
charged but  eventually  undergoes  resorption  unless  recog- 
nized and  removed  by  surgical  interference.  The  vast  ma- 
jority of  cases  of  endometritis  during  the  puerperal  period 
are  unquestionably  continuations  of  the  endometritis  of 
pregnancy,  but  to  these  must  be  added  some  cases  of  the  in- 
vasion of  the  uterine  cavity  immediately  after  the  termina- 
tion of  pregnancy. 

The  clinical  manifestations  of  endometritis  consist  chiefly 
of  the  discharge  from  the  vulva  of  varying  amounts  of  a 
scarlet-gray  exudate,  apparently  scarlet  blood  intimately 
mixed  with  dirty  gray  or  grayish  yellow  masses  of  pus  or 
tissue  debris,  usually  thick  like  a  heavy  gruel.  It  adheres 
to  the  tail,  exterior  of  the  vulva  and  surrounding  parts.  In 
its  most  typical  form  the  exudate  is  not  fetid,  but  has  a 
faintly  sweetish  odor.  The  appetite,  temperature  and  lacta- 
tion may  be  slightly  or  not  at  all  disturbed. 

The  discharge  may  be  clinically  evident  during  parturi- 
tion as  soon  as  the  uterine  seal  gives  way  and  the  chorion  is 
forced  against  the  uterine  wall  at  the  cervical  end,  which 
presses  out  some  of  the  endometritic  exudate  ahead  of  the 
fetus  itself.  After  the  fetus  and  its  membranes  have  been 
expelled,  the  visible  discharge  of  the  exudate  is  largely  de- 
pendent upon  the  volume  present  and  the  degree  of  tone  re- 
tained by  the  uterus.  Generally  the  discharge  is  not  promi- 
nent until  two  to  five  days  after  pregnancy  has  terminated. 
It  may  be  delayed  even  longer  and,  although  the  exudate 
may  be  present  in  considerable  quantity  (one-quarter  to 
one-half  pint) ,  no  recognizable  discharge  may  occur. 

Ideally,  physiologic  parturition  is  completed  in  the  cow  or 
heifer  in  one  and  one-half  to  two  hours,  and  no  recognizable 
uterine    discharge    follows.      If    examined    clinically,    the 


548  Diseases  of  the  Genital  Organs 

uterus  contains  no  notable  exudate.  The  time  occupied  by 
the  visible  act  of  parturition  is  fifteen  to  thirty  minutes  of 
definite  expulsive  effort,  during  which  the  calf  is  born,  fol- 
lowed immediately  by  a  period  of  one  to  two  hours  during 
which  uterine  involution  progresses  rapidly  and  the  fetal 
membranes  passively  separate  from  the  placental  areas  and 
are  then  expelled  by  the  contractions  of  the  uterus.  There  is 
an  active  and  tonic  elimination  of  the  vast  uterine  cavity 
which  existed  an  hour  or  two  before.  There  is  no  place 
within  the  uterine  cavity  for  the  retention  of  recognizable 
masses  of  blood  or  other  matter,  and  the  contraction  of  the 
uterine  walls  inhibits  hemorrhage  from  its  mucosa  or  the 
outflow  of  recognizable  quantities  of  lymph. 

When  active  infection  is  present  in  the  utero-chorionic 
cavity  of  the  pregnant  animal,  the  parturition  is  tardy.  The 
expulsion  of  the  fetus  may  require  five,  ten  or  many  more 
hours.  Dystocia  may  occur  as  a  result  of  uterine  paresis 
and  necessitate  aid.  After  the  fetus  has  been  expelled,  the 
dehiscence  of  the  fetal  membranes  is  slow  and  uncertain 
and  uterine  involution  is  tardy  and  feeble.  Then  follows  an 
exudate  into  the  uterine  cavity  (or  into  the  utero-chorionic 
cavity  if  the  fetal  membranes  are  retained)  which  tends  to 
reveal  its  presence  by  becoming  discharged  from  the  vulva. 
The  exudate  may,  however,  be  detained  in  the  uterus  for 
several  days  and  may  be  resorbed  without  any  notable  part 
of  it  having  appeared  externally. 

When  the  discharge  appears  or  for  other  reasons  a  clini- 
cal examination  is  made*  the  scarlet-gray  exudate  already 
described  may  be  found  in  the  vagina  or  uterus  or  both.  If 
the  uterus  largely  retains  its  tone,  the  exudate  is  nearly  all 
forced  out  into  the  vagina  promptly  instead  of  accumulating 
within  the  uterine  cavity.  From  one-fourth  to  one  pint  may 
accumulate  in  the  cervical  end  of  the  vagina.  If  the  uterus 
is  very  paretic,  up  to  one  gallon  or  more  of  the  exudate  may 
accumulate  in  the  cavity  while  the  vagina  may  be  free  of 
any  notable  amount.  Then  the  exudate  may  not  be  expelled 
actively,  but  be  forced  out  passively  when  the  animal  is  re- 
cumbent, owing  to  the  mechanical  pressure  of  contiguous 


Puerperal  Diseases  of  the  Uterus  549 

viscera  upon  the  paralyzed  distended  uterus.  Thus  invol- 
untary discharges  of  large  volumes  of  scarlet-gray  exudate 
are  observed  frequently  behind  recumbent  cows  which 
otherwise  appear  well.  Upon  rectal  palpation  the  uterus  of 
such  a  cow  is  enlarged,  atonic  and  iiabby.  Whatever  the 
amount  of  exudate  present,  the  walls  of  the  uterus  are  not 
ordinarily  stretched,  but  lie  dormant  and  powerless.  If  the 
uterine  cavity  is  douched,  there  may  be  siphoned  or  washed 
out  a  variable  quantity  of  scarlet  exudate. 

In  the  abattoir  endometritis  of  the  type  described  is  com- 
mon. Apparently  dairymen  and  breeders  frequently  dis- 
card females  which  have  recently  aborted,  owing  to  the  com- 
mon theory  that  a  cow  or  heifer  which  has  aborted  because 
of  intra-uterine  infection  should  be  isolated  in  order  to  pre- 
vent the  "spread  of  contagious  abortion"  to  other  pregnant 
females  in  the  same  herd,  which  already  have  in  large 
measure  the  same  infections  in  their  uteri.  Every  grade  of 
endometritis  is  seen.  When  of  an  aggravated  degree,  it  is 
officially  designated  "recent  parturition"  and  the  carcass  is 
condemned  by  the  inspectors,  but  as  a  matter  of  fact  it  is 
not  a  consequence  of  recent  physiologic  parturition.  The 
uterus  in  these  cases  is  readily  recognized  by  external  ap- 
pearances. It  varies  from  twenty-four  to  sixty  or  more 
inches  in  length  along  its  convex  (free)  border,  and  trans- 
versely from  three  to  eight  or  ten  inches  at  the  base  of  the 
recently  gravid  horn.  The  uterus  is  flat,  collapsed,  thin- 
walled,  and  flabby.  It  collapses  from  side  to  side :  that  is, 
it  collapses  like  an  empty  bag  with  the  line  of  attachment  of 
the  mesometrium,  or  broad  ligament  of  the  uterus,  and  the 
convex,  free  border  serving  as  the  two  margins  of  the  flat- 
tened tube.  The  exterior  of  the  uterus  shows  scarlet  or  red 
vascular  lines,  and  here  and  there  numerous  bright  red 
hemorrhages  beneath  the  peritoneum.  When  incised,  the 
uterine  cavity  is  found  to  contain  variable  quantities  of 
bright  red  exudate  mixed  with  pus  and  placental  debris  of 
a  dirty  grayish-yellow  color,  which  as  a  rule  is  not  fetid  but 
has  a  faintly  sweetish  odor. 


550  Diseases  of  the  Genital  Organs 

I  am  not  aware  that  this  exudate  has  been  subjected  to 
any  material  study.  Hence  its  composition  and  the  identity 
of  the  bacteria  present  are  unknown.  Logically  the  bacteria 
are  chiefly  those  which  existed  in  the  utero-chorionic  cavity 
of  the  recently  pregnant  organ,  to  which  organisms  from 
the  exterior  may  have  been  added.  So  far  as  I  have  been 
able  to  determine,  the  exudate  consists  primarily  of  blood 
due  to  limited  capillary  hemorrhage  from  the  placental 
areas.  This  becomes  mixed  with  small  masses  of  pus  and 
necrotic  particles  of  placental  tissue.  The  blood  is  scarlet, 
similar  to  that  of  the  severe  uterine  hemorrhage  described 
in  the  preceding  article.  Perhaps  there  is  a  causal  rela- 
tionship between  the  two  conditions.  There  is  one  marked 
clinical  difference.  The  gross  hemorrhage  produces  a  clot 
which,  so  far  as  I  have  seen,  tends  to  desiccate  but  not  to 
putrefy.  The  same  tendency  is  present  for  a  brief  interval 
in  the  scarlet-gray  exudate  of  endometritis,  but  this  is  of 
brief  duration  and,  unless  recovery  promptly  occurs,  putre- 
faction or  suppuration  finally  takes  place.  Then  follows 
septic  metritis,  pyometra,  or  other  phases  of  intra-uterine 
infection. 

Endometritis  is  exceedingly  common  in  most  dairy  and 
beef  herds.  In  dairy  herds  where  genital  infections  are  se- 
vere, endometritis  is  sometimes  essentially  universal  for 
some  months.  If  there  are  25  per  cent,  of  observed  expul- 
sion of  fetal  cadavers  (abortion),  careful  clinical  study  will 
reveal  probably  80  to  90  per  cent,  of  cases  of  endome- 
tritis. Endometritis  in  the  cow  is  so  common  that  Fleming 
and  other  obstetrists  describe  it  as  "normal"  and  designate 
the  exudate  when  discharged  from  the  vulva  as  "lochia." 
The  course  of  puerperal  endometritis  is  technically  brief. 
Numerous  cases  recover  spontaneously  and  promptly  and 
retain  their  fertility.  Perhaps  more  frequently  the  puer- 
peral infection  passes  over  into  the  post-puerperal  era  as  a 
mild,  persistent  endometritis  with  a  pernicious  tendency  to 
extend  by  continuity  into  the  oviducts,  causing  the  various 
tubal  infections,  or  into  the  cervix,  inducing  cervicitis,  with 
all  that  these  mean  for  the  future  reproductive  powers  of  the 


Puerperal  Diseases  of  the  uterus  551 

animal.  In  other  cases  endometritis  passes  quickly  into 
that  type  of  disease  I  have  designated  as  septic  metritis,  or 
into  pyometra. 

The  prognosis  is  generally  good.  If  timely  attention  is 
given  it  can  usually  be  promptly  controlled  and  the  fertility 
of  the  patient  retained.  Sometimes  the  infection  is  of  high 
virulence,  or,  which  amounts  to  the  same  thing,  the  patient 
has  such  low  resistance  that,  in  spite  of  treatment,  ruinous 
or  fatal  septic  metritis  ensues. 

The  handling  of  puerperal  endometritis  is  to  be  based 
upon  the  fact  that  it  is  ordinarily  a  disease  persisting  from 
the  pregnant  state.  Therefore,  if  it  is  to  be  prevented,  the 
uterus  should  be  rendered  as  nearly  aseptic  as  is  practicable 
prior  to  conception  and  all  available  precautions  taken 
against  coital  infection  by  the  bull.  When  genital  infec- 
tions in  a  herd  have  become  intense  as  a  result  of  profes- 
sional neglect,  each  female  should  be  regarded  as  probably 
infected  and  the  presence  of  endometritis  at  the  close  of 
pregnancy  anticipated.  In  such  instances  I  have  advised 
as  a  general  procedure  the  introduction  of  iodoform  with 
boric  acid,  bismuth,  thymol  or  other  antiseptics  into  the 
uterine  cavity  (or  if  the  fetal  membranes  are  retained,  into 
the  chorionic  cavity).  A  very  satisfactory  formula  is  one- 
half  ounce  each  of  powdered  iodoform  and  boric  acid,  with 
five  or  six  grains  of  powdered  thymol  enclosed  in  a  gelatin 
capsule  and  deposited  deeply  in  the  cavity  of  the  gravid 
horn.  This  should  be  done  within  two  to  five  hours  after 
calving  or  aborting.  This  can  be  done  safely  by  an  intelli- 
gent herdsman  or  caretaker,  if  he  has  first  been  carefully 
instructed  regarding  the  necessity  for  cleansing  his  hands 
and  shown  how  and  where  to  deposit  the  capsule.  The 
operation  must  of  course  be  carried  out  with  the  greatest 
possible  care  in  cleansing  and  disinfecting  the  hands,  and 
the  cow's  tail,  buttocks,  and  vulva.  The  same  result  may 
be  accomplished,  sometimes  perhaps  better  and  sometimes 
not  so  well,  by  suspending  the  iodoform  and  boric  acid  in 
white  mineral  or  other  bland  oil  and  introducing  the  prepa- 
ration deeply  into  the  uterus  by  means  of  a  hospital  irriga- 
tor with  the  bull-douching  catheter  attached. 


55- 


Diseases  of  the  Genital  Organs 


It  has  been  objected  that,  if  the  drugs  are  introduced  in 
the  gelatin  capsules,  the  latter  may  become  coated  with 
mucus  and  fail  to  dissolve.  I  do  not  regard  this  as  a  for- 
midable objection.  I  have  not  observed  the  result  alleged 
and  think  the  occurrence  so  rare  that  the  objection  is  not 
weighty.  If  the  veterinarian  fears  the  non-solution  of  the 
capsule,  the  defect  is  readily  overcome  by  turning  to  the 
less  convenient  suspension  in  oil.  Objection  has  also  been 
raised  to  the  use  of  iodoform  because  of  its  odor.  The  claim 
is  made  that  it  contaminates  the  entire  dairy,  gets  into  the 
milk,  etc.  I  do  not  regard  the  objection  as  well  taken.  If 
iodoform  is  properly  used,  all  objection  regarding  its  odor 
and  the  tainting  of  milk  disappears.  Introduced  into  the 
uterus  in  a  gelatin  capsule,  none  of  the  drug  needs  to  be 
scattered  about  the  stable  or  premises,  and,  once  deposited 
in  the  uterus,  its  high  specific  gravity  causes  it  to  drop  to 
the  lowest  part  of  the  cavity  and  to  remain  there  unless  dis- 
turbed by  siphoning  fluids  from  the  uterus.  When  suspended 
in  oil,  the  iodoform  is  quite  firmly  held  and  causes  little  diffi- 
culty except  that  the  mixture  is  slopped  about  in  an  untidy 
manner.  The  tainting  of  the  milk  of  the  patient  with  iodo- 
form is  a  minor  complaint  when  properly  handled.  The 
milk  is  wholly  unobjectionable  for  the  feeding  of  calves  or 
other  animals.  As  a  rule  the  milk  of  a  cow  which  has  endo- 
metritis should  be  excluded  from  the  market,  and  the  iodo- 
form taint  insures  the  exclusion  of  the  milk  for  human  use 
much  as  the  application  of  kerosene  to  a  condemned  car- 
cass insures  against  the  sale  of  the  meat  for  human  use. 
If  proper  warning  is  given  the  dairyman  that  the  milk 
should  be  carefully  tasted  by  a  good  taster  before  it  is  placed 
with  market  milk,  all  danger  is  safely  averted.  If  the  dairy- 
man ignores  the  warning,  the  tainted  milk  is  wholly  without 
danger  to  the  intended  consumer  and  only  brings  into  dis- 
repute products  of  the  careless  person.  The  warning  should 
be  direct  and  complete.  The  animal  should  be  in  isolation 
during  treatment,  a  separate  pail  should  be  set  aside  exclu- 
sively for  her  milk,  and  the  milker  should  milk  her  last  and 
then  carefully  wash  his  hands  with  hot  water  and  soaj).     It 


Puerperal  Diseases  of  the  Uterus  553 

can  not  be  too  strongly  insisted  that  the  use  of  iodoform  is 
perfectly  safe  and  that  only  its  misuse  makes  trouble. 

In  highly  infected  herds  it  is  desirable  that  a  skilled  vet- 
erinarian shall  examine  the  genital  organs  of  cows  in  which 
pregnancy  has  recently  terminated,  where  no  external  evi- 
dence of  important  disease  is  manifest,  in  order  to  deter- 
mine the  presence  or  absence  of  endometritis  or  other  hidden 
disease  important  for  the  breeding  life  of  the  animal.  This 
examination  may  occur  at  any  time  from  the  fourth  to  the 
fifteenth  day  post  partum. 

When  the  simple  type  of  endometritis  here  considered  is 
recognized  by  clinical  manifestations  or  through  a  careful 
examination  of  the  uterus,  including  the  douching  of  its 
cavity  in  order  to  reveal  the  state  of  its  interior,  the  uterus 
should  be  washed  clean  with  sterile  0,6  to  0,7  per  cent,  salt 
solution,  after  which  iodoform  and  bismuth  suspended  in 
white  mineral"  oil  or  liquid  paraffin  may  be  deposited  in  the 
recently  gravid  horn,  and  the  treatment  repeated  after  one  to 
four  or  more  days.  Careful  watch  should  be  kept  upon  the 
case  in  order  to  assure  as  far  as  possible  prompt  and  com- 
plete recovery  with  fertility  fully  maintained.  Powerful 
antiseptics  are  to  be  strictly  barred  from  the  genital  tract 
during  the  puerperal  period,  because  the  freshly  denuded 
endometrium  and  partially  denuded  vaginal  mucosa  will  not 
tolerate  them.  There  is  no  potent  disinfectant  known  which 
can  be  freely  and  safely  used  in  the  puerperal  uterus  or  va- 
gina. Insoluble  non-irritant  drugs,  such  as  iodoform  and 
bismuth,  are  well  borne  and  such  feeble  antiseptics  as  boric 
acid  can  be  tolerated.  Here  and  there  some  manufacturer  of 
antiseptics  advertises  a  "non-irritant"  drug  of  higher  po- 
tency than  carbolic  acid,  but  it  is  non-irritant  only  upon  non- 
irritable  tissues  and  not,  so  far  as  known  to  me,  upon  the 
puerperal  uterus  and  vagina.  Salt  solution  is  safest.  Da- 
kin's  solution  or  one  of  its  reliable  substitutes  in  sufficiently 
high  dilution  may  be  used.  No  drug  should  be  used  which 
causes  pain  or  straining.  Nothing  so  intensifies  the  infec- 
tion present  as  the  imprudent  use  of  disinfectants.  The  con- 
stant aim  should  be  to  wash  out  mechanically  any  deleteri- 


554  Diseases  of  the  denital  Organs 

ous  infection  present  with  a  neutral  fluid  and  then,  if  possi- 
ble, to  deposit  in  the  organ  some  long-enduring  substance, 
like  iodoform  and  bismuth,  which,  without  irritating  the 
tissues,  may  tend  to  inhibit  in  some  degree  bacterial  activity. 
The  final  effectual  disinfection  must  be  a  physiologic  act 
upon  the  part  of  the  organ  itself.  When  the  disease  ad- 
vances to  constitute  septic  metritis  or  pyometra.  or  retreats 
to  become  the  endometritis  of  the  post-puerperal  period,  the 
clinical  phenomena  change,  the  indications  for  handling 
shift,  and  the  continuing  disease  is  most  profitably  discussed 
under  other  headings. 

C.  Septic  Metritis 

The  term  "septic  metritis"  is  used  here  to  designate  a  type 
of  uterine  infection  in  which  the  invading  organisms  break 
down  the  barriers  formed  by  the  body  of  the  host,  involve 
the  uterine  tissues  generally,  and  gain  the  blood  stream, 
where  they  cause  marked  sepsis  with  great  peril  to  the  life 
of  the  patient. 

Uterine  gangrene  occurring  during  pregnancy,  associated 
with  emphysematous  decomposition  of  the  fetus,  has  al- 
ready been  described  and  it  has  been  stated  that  severe  sep- 
tic metritis  or  uterine  gangrene  not  infrequently  reveals 
itself  at  the  time  for  parturition  and  serves  to  delay  or  pre- 
vent the  expulsion  of  the  fetus.  Most  cases  of  septic  metri- 
tis occur  during  the  puerperal  period  and  are  clinically  rec- 
ognizable as  a  rule  from  two  to  seven  days  post  partum. 

The  gangrenous  or  septic  metritis  of  pregnancy  is  funda- 
mentally identical  with  the  puerperal  disease,  but  is  modified 
by  the  presence  of  the  decomposing  fetus.  Septic  metritis 
is  not  ordinarily  an  initial  or  basic  disease,  but  rather  a 
critical  phase  of  metritis  growing  out  of  a  less  virulent 
phase  of  infection.  Puerperal  septic  metritis  is  not  ordi- 
narily the  result  of  an  invasion  during  the  puerperal  period, 
but  an  inheritance  from  pregnancy,  proceeding  from  sources 
identical  with  those  of  the  uterine  gangrene  in  the  preg- 
nant cow.  After  parturition  there  may  be  important  new 
invasions  added  to  the  existing  infection.    These  admittedly 


Puerperal  Diseases  of  the  Uterus 


555 


complicate,  and  in  many  instances  doubtless  aggravate  the 
disease  already  present. 

Septic  metritis,  as  seen  during  the  puerperal  period,  com- 
monly follows  tardy  parturition.  There  is  metritis  present 
during  pregnancy  which  serves  to  cause  a  varying  degree 
of  uterine  paresis.  The  expulsion  of  the  fetus  is  tardy,  re- 
quiring five  to  ten  or  more  hours.  Afterward  the  fetal 
membranes  frequently  remain  incarcerated.  The  clinical 
evidences  of  endometritis,  as  described  in  the  previous  arti- 
cle, are  present.  The  endometritis,  instead  of  undergoing 
rapid  improvement  as  is  commonly  observed,  becomes  ag- 
gravated. The  exudate  in  the  uterus  increases  in  volume 
and  becomes  fetid.    It  loses  its  bright  scarlet  color  with  the 


Fig.  179 — Septic  Metritis,  Uterus  of  Cow,  with  Great 

Thickening  of  "Walls. 

C,  Cervical  canal  ;   U,  uterine  cavity  ;  A,  enlarged,  thickened   uterine 

arteries  ;  B,  uterine  body  walls  ;   UC,  uterine  cornua. 


556  Diseases  of  the  Getiital  Orgajis 

dirty  yellowish-gray  admixture  of  particles,  and  frequently 
becomes  watery,  dark  reddish-brown  or  black.  Its  color 
and  consistency  vary.  Sometimes  the  dark  liquid  is  mixed 
with  a  large  proportion  of  dirty  grayish  clumps  of  pus  or  of 
necrotic  tissues. 

The  uterus  becomes  paretic.  There  may  be  little  or  no 
notable  discharge  from  the  vulva.  The  exudate  is  sometimes 
pressed  out  mechanically  when  the  animal  is  recumbent, 
but  in  many  cases  even  recumbency  fails  to  crowd  the  exu- 
date out  passively.  The  animal  is  weak  and  dull.  The 
pulse  is  rapid  and  extremely  weak.  The  nose,  ears  and  feet 
are  cold.  The  animal  moves  with  great  reluctance  and  very 
feebly.  The  respiration  is  not  materially  affected.  The 
temperature  is  erratic,  rarely  high,  not  infrequently  normal, 
and  usually  subnormal.  The  practitioner  who  is  in  the  habit 
of  thinking  that  sepsis  always  causes  fever  is  greatly  de- 
ceived :  he  may  err  in  diagnosis,  and  far  more  probably  and 
seriously  in  prognosis. 

As  the  disease  progresses,  the  patient  shows  extreme  de- 
pression. The  eyes  sink  deeply  into  the  orbits  and  the  cornea 
looks  cloudy.  There  is  a  profuse  muco-purulent  discharge 
from  the  eyes  and  nostrils.  One  of  the  most  marked  clini- 
cal features  is  the  presence  of  a  profuse  diarrhea.  The 
feces  are  very  thin,  fetid,  black,  and  tarry-looking.  The 
diarrhea  is  so  pronounced  and  so  overshadows  other  clini- 
cal, phenomena,  especially  the  evidences  of  uterine  disease 
as  expressed  in  discharge  from  the  vulva,  that  I  have  seen 
unwary  practitioners  diagnose  dysentery  and  handle  the 
case  empirically  for  that  malady. 

The  course  is  usually  brief:  more  than  half  of  my  cases 
have  ended  in  death  within  three  to  six  days  after  the  estab- 
lishment of  the  clinical  evidence  of  sepsis.  Some  cases  im- 
prove, but  very  few  recover.  Peritoneal  adhesions,  pelvic 
abscesses,  pyaemic  abscesses  of  the  liver,  spleen  and  other 
parts,  arthritis,  and  other  complications  follow,  which  leave 
the  animals  unthrifty  and  of  little  or  no  value.  Those  which 
apparently  recover  are  very  largely  sterile  and  valuable  only 
for  beef. 


Puerperal  Diseases  of  ihe  Uterus  557 

The  disease  is  usually  solitary.  There  is  perhaps  one  case 
during  two  or  three  years  in  a  herd  of  fifty  or  more  cows.  I 
have  observed  such  solitary  cases  following  twin  pregnancy, 
apparently  due  to  increased  strain  caused  by  twins  upon  the 
infected  uterus.  Now  and  then  the  disease  breaks  in  a  herd 
as  a  virulent  storm  and  its  ravages  are  as  disastrous  as  an 
outbreak  of  one  of  the  most  dreaded  specific  diseases.  In 
one  herd  of  about  sixty  breeding  females,  this  virulent  form 
of  infection  suddenly  appeared  and  raged  throughout  the 
calving  period  of  about  ninety  days.  In  that  time  it  had 
killed  20  per  cent,  of  the  herd  and  had  ruined  another  20  per 
cent.,  so  they  had  to  be  destroyed  as  worthless  or  consigned 
to  the  butcher.  No  evidence  could  be  traced  of  recent  trans- 
fer of  the  infection  from  one  animal  to  another.  The  herd 
was  in  two  groups — adult  cows,  and  heifers  in  first  preg- 
nancy. They  were  one  mile  apart  and  separately  attended. 
They  suffered  alike.  The  heifer  group  had  been  separate 
from  the  adults  all  their  lives.  The  only  common  point  of 
contact  was  that  of  coitus  with  the  herd  bulls.  Some  of  the 
cows  had  retained  fetal  membranes;  some  had  not.  I  was 
able  to  give  them  close  personal  attention  but  was  powerless 
to  ameliorate  or  modify  favorably  the  course  of  the  disease. 
It  was  as  relentless  and  overpowering  as  anthrax.  I  have 
known  similar  but  less  extensive  outbreaks  in  other  herds. 
In  one  herd  of  famous  purebreds,  five  or  six  of  the  most  valu- 
able animals  succumbed  in  rapid  succession  without  a  proper 
diagnosis  having  been  made  by  the  attending  veterinarian, 
A  second  veterinarian  of  high  repute  was  called,  who  also 
failed  to  make  a  correct  clinical  diagnosis,  and  realized  his 
error  only  when  the  death  of  the  patient  gave  opportunity 
for  an  autopsy.  The  outbreak  then  subsided  as  suddenly  as 
it  had  come. 

The  biology  of  this  type  of  infection  has  not  been  exten- 
sively studied.  A  colleague  working  briefly  in  the  severe 
outbreak  under  my  charge  reported  chiefly  a  micrococcus 
and  a  streptococcus.  The  herds  in  which  I  have  seen  or 
known  of  the  severe  outbreaks  have  suffered  liberally  from 
sterility  and  abortion,  but  not  more  than  other  herds  of 


558 


Diseases  of  tlie  dcnital  Organs 


similar  size.  Abortion  was  no  more  common  during  the 
outbreak  than  at  other  times. 

The  prognosis  of  septic  metritis  should  always  be  very 
bad,  first  for  the  life  of  the  patient,  and  second,  if  the  pa- 
tient survives,  for  her  reproductive  life. 

There  is  little  to  be  done  in  the  w^ay  of  handling.  If  the 
fetal  membranes  are  retained  and  the  veterinarian  attempts 
to  remove  them,  his  efforts  apparently  aggravate  the  dis- 
ease; if  he  leaves  the  membranes  alone,  the  patient  dies. 
It  is  impossible  to  disinfect  the  uterus;  the  infection  has 
permeated  all  the  layers  and  involved  all  tissues.  Besides, 
the  denuded  uterine  mucosa  will  not  tolerate  disinfectants 
possessing  any  material  efficiency.  If  uterine  douching  is 
attempted,  without  skill  and  care,  disaster  follows.  The 
paretic  organ  will  not  empty  itself.  If  the  fetal  membranes 
are  retained,  they  prevent  siphoning  of  the  uterine  con- 
tents by  occluding  the  opening  of  the  tube.  If  the  fluids  are 
left,  they  injure  the  uterus  by  their  weight  and  afford  addi- 
tional liquid  in  which  bacteria  may  grow.     If  liquid  is 


Fig.  179a— Large  Single-Curved  Uterine  Catheter.     Length  24 
inches,  diameter  u  inch. 


forced  into  the  uterus  with  a  pump,  the  uterus  often  rup- 
tures and  the  patient  dies.  The  treatment  must  be  con- 
servative and  mild.  Retained  fetal  membranes  may  be  re- 
moved if  they  can  be  gently  detached.  The  uterus  may  be 
douched  by  means  of  a  siphon,  but  not  with  a  double  tube. 
The  amount  of  fluid — preferably  physiologic  salt  solution — 
introduced  at  one  time  should  be  very  small,  not  more  than 
a  quart  at  first,  and  immediately  siphoned  out.  If  it  can  not 
be  siphoned  out,  no  more  should  be  added.  The  best  appara- 
tus for  douching  is  the  seven-foot  pure  gum  catheter,  de- 


Puerperal  Diseases  of  the  Uterus  559 

signed  for  douching  the  sheath  of  the  bull,  attached  to  a 
hospital  irrigator.  The  irrigator  should  be  elevated  not 
more  than  20  to  24  inches  above  the  cow.  After  douching, 
or  v^ithout  having  attempted  to  douche,  there  may  be  intro- 
duced into  the  uterine  cavity  one  to  two  pints  of  liquid  par- 
affin or  other  neutral  oil  in  which  there  has  been  suspended 
some  powdered  iodoform,  bismuth  subnitrate,  or  other  vir- 
tually insoluble  antiseptic  or  deterrent  of  bacterial  growth. 
The  uterus,  in  severe  cases,  must  not  be  massaged.  A  mas- 
sage cult  has  grown  up  recently  in  veterinary  practice,  and 
massage  is  as  frequently  applied  where  harmful  as  else- 
where. In  septic  metritis,  it  is  wholly  unjustifiable  and  ab- 
solutely dangerous. 

Usually  the  animal  neither  eats  nor  drinks.  She  should 
be  permitted  plenty  of  water  if  she  will  take  it.  She  may 
have  a  moderate  supply  of  readily  digestible  food.  The  pa- 
tient may  have  internally  repeated  small  doses  of  strych- 
nine, but  in  giving  it  the  practitioner  must  be  on  his  guard. 
She  is  hyper-sensitive  to  its  action,  and  will  not  tolerate 
the  dosage  ordinarily  advised  by  writers  upon  materia 
medica.  About  one-half  the  dose  which  would  usually  be 
given  to  an  animal  of  the  same  size  is  abundant,  but  it  may 
be  repeated  within  two  hours.  Drafts  of  strong  hot  coffee 
may  be  used.  Camphorated  oil  hypodermically  and  other 
powerful  stimulants  may  be  given.  The  best  that  can  be 
done  is  to  keep  the  patient  comfortable  and  quiet,  adminis- 
ter stimulants  prudently,  and  take  advantage  of  every  op- 
portunity to  ameliorate  or  remove  untoward  developments. 

The  biology  of  this  type  of  disease  is  too  little  known  to 
afford  any  tangible  suggestion  in  the  line  of  biologic  thera- 
peutics. 

There  are  certain  possibilites  for  preventing  septic  me- 
tritis. In  the  first  place  it  may  be  partly  prevented,  as  may 
all  genital  infections,  by  the  careful  growing  of  calves  in 
such  a  manner  as  to  minimize  the  amount  of  infection  which 
may  gain  a  permanent  habitat  in  the  genital  system.  Much 
may  be  done  at  the  time  of  breeding  by  the  application  of 
the  principles  of  sex  hygiene  and  by  insuring,  in  so  far  as 


560  Diseases  of  the  Crenital  Organs 

possible,  the  freedom  of  the  genitaha  of  both  sexes  from 
dangerous  infections.  Finally,  when  genital  infections  in  a 
herd  are  intense,  as  indicated  by  such  phenomena  as  abor- 
tion, sterility,  retained  fetal  membranes,  calf  dysentery  and 
pneumonia,  the  advent  of  septic  metritis  may  frequently  be 
avoided  by  assuming  that  each  animal  is  importantly  in- 
fected and  that  each  should  be  handled  immediately  after 
the  expulsion  of  the  fetus  as  an  infected  animal,  without 
awaiting  the  development  of  the  material  evidences  of  dis- 
ease. It  is  better  practice  to  assume  that  each  of  ten  cows 
is  importantly  infected  at  calving  time  and  so  handle  them, 
even  though  only  one  is  dangerously  infected,  than  to  treat 
them  as  sound  and  allow  the  one  badly  infected  animal  to 
develop  mortal  disease  before  notice  is  taken. 

D.     Placentitis.      Cotyledonitis.     Retained  Placenta.      Retained 
Fetal   Membranes 

Metritis  can  not  readily  exist  in  the  pregnant  uterus  with- 
out involving  the  cotyledons  or  placentules,  nor  can  the  con- 
verse well  be  true — that  the  cotyledons  may  become  import- 
antly infected  without  the  intercotyledonal  mucosa  partici- 
pating. Retained  placenta  is  therefore  a  type  of  intra- 
uterine infection  which  has  become  established  during  preg- 
nancy and  becomes  clinically  recognizable  after  the  fetus, 
alive  or  dead,  has  been  expelled.  The  cotyledons  may  be 
more  notably  involved  than  the  inter-cotyledonal  or  non- 
placental  mucosa,  but  the  only  practical  difference  between 
the  various  types  of  puerperal  metritis  and  retained  fetal 
membranes  is  that  in  the  latter  the  endometrium  is  hidden 
everywhere  beneath  the  chorion,  the  necrotic  fetal  mem- 
branes quickly  undergo  putrefaction,  and  the  retention  of 
the  membranes  imprisons  the  pus  in  the  utero-chorionic 
cavity,  thus  preventing  its  discharge  and  largely  concealing 
its  presence. 

When  parturition  ends,  in  a  healthy  cow.  the  moment  that 
the  umbilic  cord  parts  the  life  of  the  chorion  ceases.  If,  as 
naturally  occurs,  the  chorionic  end  of  the  umbilic  cord  is  let 
alone  when  it  has  parted,  the  blood  contained  within  the 


Puerperal  Diseases  of  t lie  Uterus 


>6i 


fetal  placental  arteries,  capillaries  and  veins  escapes  from 
the  ruptured  umbilic  veins,  causing  the  placental  capillaries 
of  the  fetus  to  collapse,  become  greatly  reduced  in  volume, 
and  drop  away  from  the  capillaries  of  the  maternal  placental 
crypts.  There  was  at  no  time  any  anatomical  bond  of  union, 
but  only  an  intimate  contiguity  maintained  by  a  mutual  at- 
traction existing  between  the  healthy  uterus  and  living  fetal 
envelopes.  When  the  umbilic  cord  ruptures  and  the  chori- 
onic end  is  necrotic,  the  attraction  between  it  and  the  uterus 
ceases.  If  it  is  to  be  retained,  the  retention  is  necessarily 
dependent  upon  a  pathologic  condition  which  can  not  develop 
after  the  expulsion  of  the  fetus,  whether  alive  or  dead,  but 
is  dependent  absolutely  upon  the  persistence  of  a  metritis 
which  existed  in  the  pregnant  uterus.  The  expulsion  of  the 
fetus  does  not  cause,  nor  permit  other  factors  to  cause,  re- 
tention of  the  membranes,  but  fetal  expulsion  reveals  the 
uterine  disease  and  opens  the  way  for  important  modificar 
tions  and  complications  in  its  course. 

The  bovine  placental  structures  are  the  most  complex  seen 
in  domestic  animals.   While  the  placental  system  of  the  ewe 


Fig.  i8o— Retained  Placenta  showing-  incarceration  and  disintegra- 
tion of  the   choriotic  tufts  ( fot  i  and  extensive  infiltration  with 
leucocytes  in  the  maternal  portion,  some  of  them  already- 
broken  down.     X  310  I  After  Pomayer). 

36 


562 


Diseases  of  the  Genital  Organs 


^ 

'    '*'  ^>v 

/                               : 

'  'V- 

\  ^    ^: 

^^ 

Fig.  i8i— Retained  Placenta.     The  chorionic  tufts  (fot)  degenerated. 

the  maternal  crypt  walls  (mat.)  becoming  disintegrated 

and  necrotic.     (After  Pomayer). 


Fig.  182— Retained  Placenta.     Necrotic  disintegration  of  fetal  tufts 

(fcit)  and  extensive  inflammation  with  infiltration  in  the 

maternal  placentae,     x  900.     (.Vfler  I'oiiiaver). 

(See  also  Plate  V.) 


Puerperal  Diseases  of  the  Uterus  563 

is  similar  in  plan,  the  chorionic  tufts  are  not  so  large  and 
hence  the  cotyledonal  crypts  of  the  uterus  are  not  so  deep 
and  intricate  as  in  the  cow.  This  is  well  shown  by  a  study 
of  the  placental  systems  of  the  two  animals  on  pages  59  to 
66,  including  Figures  27  to  34.  When  infection  invades  the 
placental  structures,  it  is  virtually  impossible  for  the  ma- 
ternal crypts  to  become  inflamed  without  the  intimately  con- 
tiguous chorionic  tufts  promptly  becoming  involved.  As  in 
inflammations  involving  other  parts,  so  in  the  placental 
tissues,  the  capillaries  become  engorged,  the  blood  stream 
slows  and  finally  stops,  the  red  blood  cells  heap  up  and  per- 
ish, and  the  white  blood  cells  pass  out  through  the  capillary 
walls  into  the  intervening  spaces.  The  result  is  indicated  in 
Figures  180-182.  The  accumulation  of  the  red  blood  cells  in 
the  capillaries  and  the  migration  of  the  leucocytes  into 
neighboring  tissues,  with  the  extravasation  of  lymph  and  of 
red  cells  into  the  parts,  increase  greatly  the  volume  of  the  in- 
dividual structures,  such  as  the  chorionic  tufts,  and  through 
this  detailed  enlargement  the  volume  of  the  structure  as  a 
whole  becomes  vastly  increased.  The  inflamed  cotyledon  is 
frequently  quadrupled  in  volume  because  of  the  disease.  The 
result  is  incarceration  of  the  enlarged,  swollen  chorionic 
tufts  within  the  similarly  enlarged  placental  crypts.  The 
placenta  is  retained.  The  pathologic  processes  involved  in 
retention  of  the  fetal  membranes  probably  occur  in  all  cases 
of  abortion  but  are  not  always  recognizable.  The  uterus  of 
the  female  bovine  fetus  shows  clearly  the  placental  areas. 
When  a  heifer  becomes  pregnant,  the  placental  areas  have 
already  been  fixed  and,  as  soon  as  the  embryonic  sac  is  es- 
tablished, the  placental-contact  points  of  the  chorion  throw 
out  placental  tufts  which  enter  the  cotyledonal  crypts  and 
quickly  establish  a  physiologic  bond  of  intimate  contiguity. 
As  pregnancy  advances  the  chorionic  tufts  grow  larger, 
longer,  and  more  intricately  branched,  and  the  cotyledonal 
crypts  become  constantly  deeper  and  more  complex.  It  is 
not  probable  that  a  fetus  ever  dies  until  some  or  all  pla- 
cental areas  have  undergone  serious  pathologic  changes  of 
a  character  essentially  identical  with  retained  fetal  mem- 


564  Diseases  of  the  Genital  Organs 

branes.  In  the  early  stages  of  pregnancy,  however,  the 
chorionic  tufts  and  placental  crypts  are  so  primitive  that 
recognizable  incarceration  does  not  occur  because  the  pla- 
cental disease  quickly  runs  its  course  and  placental  separa- 
tion occurs  prior  to  fetal  expulsion,  so  that  the  abort  is  ex- 
pelled, enclosed  within  its  membranes.  As  pregnancy  ad- 
vances, the  increasingly  complex  placental  structures  invite 
an  equally  increasing  incarceration  of  the  chorionic  tufts, 
until  in  the  sixth  or  seventh  month  the  expulsion  of  the 
fetal  cadaver  usually  reveals  the  presence  of  a  severe  pla- 
centitis, as  evidenced  by  the  retention  of  the  fetal  mem- 
branes. When  a  cow  or  heifer  aborts,  the  probability  of  re- 
tention of  the  fetal  membranes  increases  as  she  approaches 
full  term  and  the  intensity  of  the  retention  increases 
along  parallel  lines.  If  the  intra-uterine  infection  is  ex- 
tensive but  fails  to  accomplish  the  death  of  the  fetus  and 
its  expulsion,  there  occurs  at  birth  a  retention  of  fetal 
membranes  often  more  severe  and  perilous  than  observed 
after  abortion.  When  abortion  occurs  at  a  late  date,  reten- 
tion of  the  membranes  after  the  expulsion  of  the  fetal  cada- 
ver may  not  occur,  because  the  placentitis  has  completed  its 
course  up  to  the  point  of  dehiscence  of  the  chorionic  pla- 
centae. That  is,  there  is  no  invariable  rule  of  relationship 
between  the  death  of  the  fetus  and  its  expulsion  from  the 
uterus.  They  are  two  separate  phenomena.  The  irritation 
in  the  uterus  due  to  the  endometritis  may  excite  uterine  con- 
tractions and  cause  the  expulsion  of  the  fetus  while  the 
latter  is  yet  alive  (premature  birth).  Usually  the  death  of 
the  fetus  and  its  expulsion  from  the  uterus  occur  almost 
simultaneously,  so  that  the  fetal  cadaver  is  fresh  when  ex- 
pelled. But  the  fetal  cadaver  may  be  detained  in  the  uterus 
for  an  indefinite  period  for  any  one  of  not  less  than  three 
different  reasons:  (1)  The  expulsion  of  the  embryo  may  be 
delayed  or  prevented  by  cervicitis  with  sclerosis  or  adhesions 
of  the  cervical  tissues.  (2)  The  uterus  may  be  too  parotic 
to  expel  promptly  the  fetal  cadaver.  (3)  The  expulsion  of 
the  cadaver  may  be  inhibited  by  the  presence  in  the  uterus  of 
a  second  living  fetus  (twins).  The  latter  force  is  more  nota- 


Puerperal  Diseases  of  the  Uterus  565 

ble  in  the  sow,  where  the  fetal  cadavers  are  common  in  the 
uterus  and  their  expulsion  inhibited  by  the  presence  of  liv- 
ing embryos.  In  each  of  these  conditions  the  placentitis 
completes  its  course,  at  least  up  to  the  point  of  detachment 
of  the  fetal  from  the  maternal  placentae,  or  the  cotyledons 
become  necrotic  and  separate  from  the  uterus.  Conse- 
quently if  the  cadaver  is  finally  expelled,  the  fetal  mem- 
branes do  not  remain  behind  in  the  uterus.  Accordingly 
when  retained  fetal  envelopes  occur,  the  stage  of  their  de- 
velopment varies  widely  in  different  cases.  In  abortion  oc- 
curring late  in  pregnancy  the  placentitis  may  be  far  ad- 
vanced, so  that  the  fetal  membranes  are  expelled  with  the 
fetal  cadaver,  or,  detained  after  the  expulsion  of  the  cada- 
ver, may  come  away  in  a  few  hours,  days  or  weeks. 

If  a  cow  calves  and  the  fetal  membranes  are  retained,  the 
stage  of  the  placentitis  may  be  partly  gauged  by  the  health 
of  the  calf.  If  the  calf  is  feeble  and  dull,  showing  severe 
sepsis,  the  placentitis  is  probably  far  advanced  and  the 
course  of  retention  nearing  completion.  If  the  calf  seems 
well  but  breaks  down  within  a  few  days  with  dysentery,  it 
indicates,  with  certain  limitations,  that  the  placentitis  was 
moderately  advanced  at  the  time  of  birth  and  that  the  re- 
tention of  the  membranes  will  probably  continue  for  the 
maximum  duration.  On  the  other  hand,  if  placental  reten- 
tion follows  the  birth  of  a  quite  vigorous  calf,  the  placentitis 
is  certainly  in  its  first  stages  and  probably  involves  materi- 
ally only  a  few  of  the  cotyledons  located  at  the  cervical  end 
of  the  uterus,  while  the  cotyledons  at  the  ovarian  end  are 
healthy.  Then  the  dehiscence  of  the  membranes  at  the 
ovarian  end  of  the  uterus  may  occur  at  once  and  these 
drag  upon  the  areas  of  detention,  mechanically  detaching 
the  feebly  retained  portions.  Slight  retention  of  the  fetal 
membranes  at  the  cervical  end  of  the  uterus  plays  an  im- 
portant part  in  the  phenomenon  of  their  final  expulsion. 
Ideally  it  might  be  expected  that  the  fetal  membranes  w^ould 
be  expelled  with  the  placental  surface  of  the  chorion  on  the 
outer  side,  but  in  a  majority  of  instances  the  dehiscence  oc- 
curs first  at  the  ovarian  end  of  the  uterus,  the  detached  por- 


566  Diseases  of  the  Genital  Organs 

tion  inverts  into  the  cervical  portion  and  finally  prolapses, 
and  the  afterbirth  comes  away  v^^ith  the  amniotic  surface  of 
the  chorion  external. 

The  duration  of  the  retention  of  the  fetal  membranes  is 
further  modified  by  the  virulence  of  the  infection.  The  mild- 
est recognizable  type  may  have  only  a  brief  duration  be- 
cause the  involved  tissues  retain  or  recover  in  part  their 
physiologic  functions  and  act  effectively  before  firm  incar- 
ceration occurs.  At  the  other  extreme,  even  when  a  calf  is 
born,  the  infection  may  be  so  virulent  as  to  cause  necrosis  of 
all  the  cotyledons  with  sloughing  through  their  necks  within 
two  or  three  days  after  calving,  thus  ending  the  retention. 

The  symptoms  of  retained  fetal  membranes  are  those  of 
the  underlying  metritis  with  the  addition  of  the  recognized 
presence  of  the  membranes.  The  retention  of  the  membranes 
is  usually  evident  because  some  portions  protrude  from  the 
vulva.  The  part  most  commonly  protruding  is  the  umbilic 
cord,  but  it  may  be  a  portion  of  the  amnion,  or  the  chorion 
from  the  non-gravid  horn. 

Retained  fetal  membranes  are  not  always  visible.  If  the 
uterus  is  very  paretic  so  that  involution  is  very  imperfect 
and  the  uterus  retains  approximately  its  gravid  size,  the 
retention  of  the  membranes  at  the  ovarian  end  retracts  the 
stump  of  the  umbilic  cord  into  the  vagina  or  even  into  the 
uterine  cavity.  The  retention  then  becomes  recognizable 
only  upon  clinical  examination.  This  coUvStitutes  one  of  the 
most  dangerous  types  of  retention  because  the  layman  fails 
to  recognize  it,  and  the  veterinarian,  unless  on  his  guard, 
may  err  in  diagnosis.  It  finally  leads  to  another  interest- 
ing phase  of  retention  of  the  fetal  membranes.  When  the 
placentitis  has  finally  run  its  course  to  that  point  where  the 
membranes  are  no  longer  attached  to  the  uterus,  whether 
detachment  has  occurred  through  suppuration  within  the 
crypts  or  necrosis  of  the  cotyledons,  the  cervix,  which  has 
not  participated  extensively  in  the  disease  processes,  may 
have  so  contracted  that  the  enfeebled  uterus  is  unable  to 
force  out  the  loose-lying  membranes,  with  perhaps  the  ne- 
crotic cotyledons  still  attached  to  the  membranes  and  de- 


Puerperal  Diseases  of  the  Utertis  567 

tached  from  the  uterus.  There  exists  then  what  may  be 
designated  cervical  retention  of  the  fetal  membranes.  A 
condition  has  developed  analogous  to  retention  of  the  fetal 
cadaver.  Unless  surgically  removed,  the  membranes  then 
undergo  putrid  destruction  and  establish  pyometra  or  other 
serious  type  of  disease  of  indefinite  duration. 

The  biology  of  the  infection  causing  retention  of  the  fetal 
membranes  has  not  been  adequately  or  seriously  studied. 
The  orthodox  believers  in  ''contagious  abortion"  as  a  spe- 
cific contagious  disease  have  neither  asserted,  admitted,  nor 
denied  that  B.  abortus  causes  retention  of  the  fetal  mem- 
branes. They  freely  admit  and  assert  that  abortion  is 
"followed"  or  "complicated"  by  retention  of  the  fetal  envel- 
opes. In  their  directions  for  the  control  of  "contagious 
abortion",  however,  they  constructively  deny  the  identity 
of  the  infection  causing  abortion,  and  of  that  causing  the 
retained  placenta  of  calving,  by  advising  that  aborters  be 
quarantined  and  ignoring  the  cow  which  has  calved  and  has 
retained  fetal  membranes.  Brief  researches  by  my  col- 
leagues intimate  that  the  chief  factor  in  the  causation  of 
retained  fetal  membranes  is  a  streptococcus  of  the  viridans 
group  associated  at  times  with  a  colon  bacillus.  The  latter 
may  be  largely  a  secondary  invader.  Very  rarely  tubercu- 
losis and  actinomycosis  may  cause  retention  of  the  fetal 
membranes.  Reference  to  this  possibility  has  been  made 
when  considering  genital  actinomycosis  and  tuberculosis. 
Any  infection  which  may  invade  or  exist  within  the  gravid 
uterus  and  which  is  competent  to  cause  inflammation  may 
cause  retention  of  the  fetal  membranes.  After  the  expul- 
sion of  the  fetus,  or  rather  after  the  uterine  seal  disappears 
from  the  cervical  canal,  an  unknown  number  of  species  of 
bacteria  may  invade  the  uterus  to  complicate  and  intensify 
retained  placenta. 

The  course  of  retained  fetal  membranes  is  ameliorated, 
intensified  or  modified  by  innumerable  factors,  and  it  is  im- 
possible to  predict  the  outcome  of  a  given  case  with  any  as- 
surance of  correctness.  The  mortality  is  high,  but  the 
greatest  economic  loss  arises  from  decreased  dairying  efli- 


568  Diseases  of  the  Genital  Organs 

ciency  during  the  involved  lactation  period,  loss  of  condi- 
tion, delay  in  conception  in  the  next  breeding  period,  and 
very  commonly  the  total  destruction  of  the  reproductive 
powers.  More  incurable  sterility  arises  from  that  type  of 
metritis  where  retained  fetal  membranes  exist  than  from 
any  other  type  of  disease.  It  is  common  to  hear  or  see 
statements  by  veterinarians  that  under  a  certain  formula 
they  "cure"  promptly  and  readily  all  cases  of  retained  pla- 
centa. Just  what  they  mean  by  such  statements  I  do  not 
know.  Retained  placenta  in  the  cow  is  a  condition  of  great 
peril,  causing  enormous  losses. 

The  placentitis  or  cotyledonitis  regularly  begins  at  the 
cervical  end  of  the  uterus  and  advances  toward  the  ovarian 
extremity.  Usually  the  spread  is  slow,  but  it  may  be  very 
rapid.  Its  extension  is  more  readily  observed  after  calving 
than  after  abortion.  If  the  uterus  is  examined  manually  a 
few  hours  after  calving,  it  is  commonly  found  that  some  of 
the  placentae  nearest  to  the  cervix  have  already  become  de- 
tached or  are  readily  separated.  Further  toward  the  ovary 
the  cotyledons  are  increasingly  enlarged,  engorged  and  firm, 
and  the  chorionic  tufts  can  be  detached  only  with  difficulty 
or  not  at  all.  The  uterus  is  generally  atonic,  flaccid  and  col- 
lapsed. Sometimes  it  is  highly  sensitive,  and  when  the 
uterus  is  manipulated  the  animal  expresses  pain  and  strains 
severely.  At  first,  if  a  calf  is  born,  the  membranes  appear 
fresh  and  possess  no  putrescent  odor.  Sometimes  putrefac- 
tion does  not  become  marked  until  several  days  have  elapsed, 
after  which  decomposition  proceeds  with  varying  rapidity. 
If  daily  examinations  are  made,  it  is  ordinarily  found  that 
at  each  time  additional  cotyledons  have  separated  or  are 
separable,  until  finally  the  last  to  become  detachable  are 
those  in  the  apex  of  the  gravid  horn.  This  is  not  constant. 
In  some  cases  the  infection  has  spread  from  cotyledon  to 
cotyledon  with  great  rapidity,  the  placentitis  is  essentially 
uniform  throughout,  and  finally,  when  the  membranes  are 
detachable  from  some  cotyledons,  they  may  be  removed  from 
all.  In  other  cases  a  few  cotyledons  at  the  cervical  end  of 
the  uterus  are  moderately  inflamed  after  calving  but  with  a 


Piierperal  Diseases  of  the  Uterus  569 

little  care  the  membranes  may  be  detached.  Anterior  to 
these  the  parts  are  essentially  healthy  and  are  readily  re- 
moved. In  these  cases  the  placentitis  is  in  its  initial  stage 
and  the  incarceration  of  the  chorionic  tufts  within  the  pla- 
cental crypts  not  fully  established.  The  separation  of  the 
fetal  membranes  from  the  diseased  uterus  occurs  in  a  va- 
riety of  ways.  Each  type  may  be  recognized  in  the  same 
case,  though  one  tends  to  prevail. 

(1)  In  the  simplest  type  of  retention,  lymph  or  pus  ac- 
cumulates within  the  placental  crypts  of  the  uterus  and 
pushes  out  or  detaches  the  chorionic  tufts.  In  a  large  meas- 
ure the  tufts  may  undergo  purulent  destruction  and  the 
chorionic  base  drop  away  with  but  few  of  its  placental  tufts 
intact.  This  constitutes  the  most  benign  type  of  retention 
and  ordinarily  runs  the  briefest  course.  The  recovery  is 
generally  prompt,  lactation  is  not  seriously  disturbed,  and 
fertility  is  usually  conserved. 

(2)  The  chorionic  tufts  and  the  placental  crypts  of  the 
uterus  become  necrotic,  the  tufts  break  off  from  the  chori- 
onic membranes,  and  later  the  placental  portions  of  the 
cotyledons,  with  the  chorionic  tufts,  slough  away  from  the 
pedicle  of  the  cotyledons  and  lie  free  in  the  uterine  cavity. 
If  the  case  is  not  meddled  with  in  an  imprudent  attempt  to 
remove  the  membranes  manually,  the  chorionic  membrane 
usually  retains  its  connection  with  the  tufts  and  the  pla- 
cental area  of  the  cotyledon  becomes  detached  from  the 
uterus  and  remains  attached  to  the  chorion.  If  the  animal 
survives  (the  mortality  is  high)  and  again  conceives  (which 
is  improbable),  new  placental  tissues  form  upon  the  cotyle- 
donal  stalks. 

(3)  In  another  well-marked  type,  which  is  not  very  rare, 
many  or  all  the  cotyledons  undergo  total  necrosis,  slough 
through  the  cotyledonal  stalk,  and  remain  irremovably  at- 
tached to  the  chorion.  While  this  process  is  being  accom- 
plished, the  cervix  may  contract;  when  the  sloughing  is  com- 
plete, the  fetal  membranes  with  the  clinging  necrotic  cotyle- 
dons lie  imprisoned  within  the  diseased  uterus.  When  all 
cotyledons  are  thus  involved,  the  patient  usually  succumbs. 


570  Diseases  of  the  Genital  Organs 

If  she  survives,  she  rarely  breeds.  If  but  a  few  cotyledons 
at  the  cervical  end  undergo  necrosis,  the  prognosis  is  far 
more  hopeful  and  the  animal  frequently  breeds.  I  have  ob- 
served in  the  abattoir  one  pregnant  uterus  in  which  all  coty- 
ledons had  perished  completely.  When  a  cotyledon  necroses 
in  toto,  placental  structures  do  not  again  form  in  that  area. 
Instead  there  is  a  white  cicatrix.  About  this  cicatrix  (See 
Colored  Plate  V)  adventitious  placental  structures  develop. 
They  lack  the  fineness  of  detail  shown  in  Figs.  27  to  34  and 
are  irregular  and  defective.  They  are  no  longer  cotyledonal 
in  type,  but  approach  roughly  the  diffuse  placenta  of  the 
mare. 

(4)  Metritis  associated  with  retained  fetal  membranes  is 
sometimes  so  severe  that  the  entire  endometrium  is  de- 
stroyed. The  uterine  epithelium  can  not  then  be  renewed 
and  the  denuded  surface  can  not  heal  except  possibly  by  ad- 
hesion of  the  denuded  surfaces  totally  oblitering  the  cavity. 
Possibly  this  occurs  sometimes.  What  I  have  observed  is 
illustrated  in  Fig.  183.  Here  the  uterine  mucosa  has  been 
wholly  displaced  by  granulation  tissue  which  has  contracted 
until  the  uterine  (and  cornual)  cavity  consists  of  an  irregu- 
lar suppurating  fistula  barely  admitting  the  passage  of  an 
ordinary  probe.  The  uterus  was  normal  on  rectal  palpation, 
the  cervical  canal  was  passable  for  the  small  uterine  cathe- 
ter, and  attempts  at  douching  the  uterus  resulted  in  the  re- 
turn of  a  few  drops  of  pus.  Probably  at  one  time  there  had 
been  sclerotic  metritis,  as  illustrated  in  Fig.  189,  but  during 
an  interval  of  three  years  after  the  termination  of  her  last 
pregnancy  any  sclerosis  which  may  have  been  present  might 
well  have  disappeared  to  such  a  degree  that  it  could  not  be 
recognized  by  rectal  palpation. 

The  handling  of  retained  fetal  membranes  is  a  trying 
problem  to  the  conscientious  practitioner.  Not  the  least 
factor  in  rendering  it  trying  is  the  frequent  bombastic  mis- 
representation as  to  how  easily  it  may  be  overcome  by  this 
or  that  formula.  Rules  for  handling  are  laid  down  by  the 
score  and  recommended  as  essentially  infallible.  This 
creates  the  utmost  confusion.    There  is  no  accepted  stand- 


Puerperal  Diseases  of  the  Uterus 


571 


Fig.  183. — Total  Destruction  of  Uterine  Mucosa. 

V,   Vagina  ;    C   cervical  canal  ;    i\    uterine  body   cavity,    virtually  disap- 

'  peared ;   UC,  walls  of  uterine  cornua  ;   I  'C\  cavity  of  uterine  cornu, 

reduced  to  a  purulent  fistula  large  enough  to  admit  a  small 

sound  ;  CL,  central  corpus  luteuni. 


572  Diseases  of  the  Genital  Organs 

ard  and  there  is  much  misinformation.  One  of  the  chief 
elements  of  confusion  is  the  belief  of  the  breeder  and  dairy- 
man that  a  skillful  veterinarian  can  successfully  remove  a 
retained  afterbirth  at  will.  Accordingly  the  ov^^ner  calls  the 
veterinarian  to  "remove"  irremovable  fetal  membranes. 
The  practitioner  is  not  left  free  to  exercise  his  judgment 
and  attempts  the  impossible. 

No  chronological  date  can  be  fixed  upon,  at  which  it  is  pru- 
dent to  attempt  the  manual  removal  of  the  fetal  membranes. 
So  many  cows  have  been  killed  or  ruined  by  attempts  at  the 
removal  of  the  membranes  that  it  has  become  the  fixed 
policy  of  many  practitioners  to  abstain  from  all  attempts 
at  manual  removal,  and  they  have  justified  their  methods 
by  results  attained.  I  hold  that,  between  the  extremes  of 
non-removal  and  the  arbitrary  removal  or  attempts  at  re- 
moval, there  is  a  middle  ground  in  thorough  harmony  with 
the  principles  of  surgery  and  fully  justified  by  clinical  ex- 
perience. Once  the  fetal  membranes  become  retained  within 
the  uterus  owing  to  the  incarceration  of  the  chorionic  tufts 
within  the  placental  crypts,  certain  established  disease  pro- 
cesses must  continue  in  their  course  to  their  logical  end.  In 
the  types  described  above  there  is  a  course  and  termination 
for  each,  and  it  is  impracticable  to  modify  materially  or  to 
abbreviate  that  course  in  a  favorable  direction.  As  in  other 
infections,  it  is  easy  to  affect  its  course  unfavorably,  leading 
to  disaster.  There  is  always  present  within  the  uterus  a  de- 
termined battle  between  the  infection  and  the  powers  of 
resistance  in  the  uterus  and  the  body  as  a  whole.  The  in- 
fection has  a  notable  advantage  in  the  presence  of  the  ne- 
crotic membranes,  which  afford  an  inexhaustible  nutritive 
supply  for  the  bacteria,  and  the  additional  advantage  of  the 
presence  of  the  utero-chorionic  cavity,  with  the  necrotic 
chorion  forming  one  wall  and  the  diseased  uterus  the  other 
wall,  and  the  virulent  infection  lying  between  the  two  struc- 
tures beyond  surgical  reach.  The  tendency  is  therefore  for 
each  case  of  retained  afterbirth  belonging  to  the  first  and 
most  benign  type,  a  group  which  fortunately  contains  most 
cases,  to  become  more  intense  and  to  move  into  one  of  the 


Puerperal  Diseases  of  the  Uterus  573 

more  perilous  types.  The  least  error  in  the  plan  of  handling 
serves  to  push  the  case  out  of  the  simpler  type  into  the  more 
serious  classes.  Everywhere  the  uterine  mucosa  is  diseased 
and  its  epithelium  depressed  or  destroyed  and  extremely 
sensitive  to  the  faintest  abuse.  If  the  practitioner  attempts 
to  detach  manually  the  chorionic  from  the  uterine  placenta, 
any  imprudent  stress  which  tears  the  walls  of  the  placental 
crypts,  or  merely  tears  away  the  already  damaged  protective 
epithelium,  creates  a  favorable  avenue  for  more  damaging 
bacterial  invasion.  The  damage  is  not  alone  to  the  placental 
areas.  The  non-placental  endometrium  is  largely  denuded 
of  its  protective  epithelium  and  is  highly  sensitive  to  the 
least  insult.  If  the  practitioner  inserts  his  hand  none  too 
gently  into  the  uterine  cavity  and  laboriously  detaches  the 
membranes  from  the  cotyledons,  his  hand  constantly  abrades 
the  inter-cotyledonal  mucosa  and  breaks  down  the  feeble 
barrier  maintained  against  the  invading  swarm  of  bacteria. 
The  pain  endured  by  the  cow  induces  severe  straining,  which 
in  turn  further  damages  the  tissues  and  increases  the  infec- 
tion. Any  veterinarian  having  mediocre  powers  of  observa- 
tion can  remember  clearly  how  in  his  own  personal  experi- 
ence he  has  left  his  patient  evidently  worse  after  having 
made  an  apparently  successful  attempt,  viewed  from  a  me- 
chanical standpoint,  to  remove  retained  membranes.  Equally 
disastrous  attempts  are  made  to  disinfect  the  uterus  and  re- 
tained membranes.  The  infected  puerperal  uterus  can  not 
be  disinfected  and  is  utterly  intolerant  of  freely  soluble  dis- 
infectants. The  necrotic  chorion  defies  disinfection  by  any 
available  means,  and  lying  behind  it  wholly  out  of  reach  is 
the  great  mass  of  infection  proceeding  with  its  destruction, 
regardless  of  any  disinfectants  placed  upon  the  opposite 
surface  of  the  chorion.  Such  a  multitude  of  errors  have 
been  made  and  are  still  being  made  that  it  is  difficult  to  lay 
down  a  line  of  action  which  may  be  advantageously  followed. 
In  principle  the  aim  should  be  to  pursue  a  course  devoid  of 
danger  of  injury  to  the  diseased  parts,  which  will  tend  to 
lessen  the  danger  of  infection  passing  from  the  milder  type 
into  one  of  the  more  severe,  or,  in  cases  where  the  very  se- 


574  Diseases  of  the  Genital  Organs 

vere  type  is  present,  to  ameliorate  it  and  if  possible  convert 
it  into  a  simpler  type. 

There  is  no  denying  that  the  presence  of  the  great  necrotic 
and  putrefying  mass  of  membranes  is  a  menace  to  the  health 
and  life  of  the  patient  and  that  the  earlier  it  is  out  of  the 
uterus  the  better,  provided  that  in  the  process  of  removal 
no  injury  is  inflicted  upon  the  uterus.  It  should  be  borne 
in  mind  that  as  a  rule  an  afterbirth  which  can  be  removed 
manually  without  injury  to  the  uterus  will  spontaneously 
drop  away  a  few  hours  later.  Hence  in  most  instances  the 
manual  removal  of  the  fetal  membranes  is  not  of  supreme 
importance  because  it  can  prudently  occur  but  a  short  time 
prior  to  spontaneous  falling  away.  The  gentlest  manual  re- 
moval possible  is  not  superior  to  the  spontaneous  dropping 
away.  There  are,  however,  important  limitations  to  these 
general  statements  which  should  call  into  action  a  high  de- 
gree of  professional  skill  and  judgment.  If  at  a  given  date 
the  practitioner  finds  that  the  membranes  can  be  prudently 
removed,  it  is  best  to  proceed  at  once  with  the  operation  in 
order  to  be  in  position  as  early  as  practicable  to  deal  di- 
rectly and  successfully  with  the  underlying  metritis. 

Before  proceeding  with  manual  removal  the  operator 
should  thoroughly  cleanse  and  disinfect  the  tail,  vulva  and 
adjacent  parts  in  order  to  avoid  the  danger  of  pushing  into 
the  genital  tract  dangerous  infections  from  the  exterior. 
The  operator  should  very  carefully  disinfect  his  hands  and 
arms  as  a  protection  to  himself  and  he  should  keep  at  hand 
ample  disinfectant  solutions  for  frequent  use.  But  the  dis- 
infectants must  be  kept  out  of  the  genital  tract.  After  dis- 
infecting the  hands  and  arms,  they  should  be  thoroughly  and 
frequently  anointed  with  vaseline,  liquid  paraffin,  or  other 
fat,  and  liquid  paraffin  should  be  introduced  in  ample 
amount  into  the  genital  tract.  By  such  means  the  mechani- 
cal irritation  from  the  operation  is  reduced  to  a  minimum. 
The  arrangement  of  the  cotyledons,  as  shown  in  Plate  I, 
should  be  kept  in  mind,  and  the  dorsal  rows  of  cotyledons 
separated  first.  Commencing  at  the  cervical  end  of  the  uter- 
us, the  hand  should  be  gently  pressed  into  the  utero-chorionic 


Puerperal  Diseases  of  the  uterus  575 

space  and  advanced  until  one  of  the  cotyledons  is  encoun- 
tered. The  chorion  should  then  be  grasped  upon  either  side 
of  the  cotyledon,  from  the  uterine  surface.  By  exerting 
traction  upon  the  placental  margins  of  the  chorion  these 
borders  should  be  pressed  toward  each  other,  which  tends 
to  cause  the  chorionic  tufts  to  pull  out  of  the  crypts  of  the 
maternal  placentae,  as  indicated  in  Figs.  29  and  30,  with- 
out traction  upon  the  cotyledonal  stalk  or  uterine  wall.  In 
many  cases  it  is  found  that,  after  separating  a  few  cotyle- 
dons at  the  cervical  end  of  the  uterus,  the  retention  is  more 
severe  anteriorly.  The  operation  needs  then  to  be  suspended, 
and  all  or  most  of  the  detached  membranes  left  connected 
with  the  undetachable  portions.  It  is  especially  important 
that  a  goodly  mass  of  membranes  be  left  in  the  cervical 
canal,  since  their  presence  tends  to  insure  a  continued  dila- 
tion of  the  part,  enabling  the  operator  to  introduce  his  hand 
at  future  dates.  If  the  detached  portions  of  the  membranes 
are  cut  or  broken  off  short,  the  remaining  portions  drop 
back  into  the  uterus,  the  cervix  contracts,  and  future  man- 
ipulations are  rendered  difficult.  The  progress  of  the  dis- 
ease is  then  to  be  carefully  watched  and  the  removal  of  the 
membranes  completed  as  early  as  prudent. 

When  the  membranes  are  permanently  undetachable  from 
the  maternal  placental  tissues  and  separate  instead  by 
necrosis  either  of  the  placental  portion  or  of  the  entire 
cotyledon,  the  membranes  with  the  necrotic  cotyledons 
should  be  removed  early  unless  they  are  promptly  expelled 
by  the  uterus.  The  latter  is  improbable,  because  as  a  rule, 
when  necrosis  of  the  cotyledons  occurs,  the  uterus  is  so 
badly  diseased  that  it  is  not  competent  to  expel  its  con- 
tents. Usually  the  necrosis  is  slow  and,  before  it  is  com- 
pleted and  the  cotyledons  sloughed  off,  the  cervix,  the  mus- 
cular walls  of  which  usually  escape  the  ravages  of  the  dis- 
ease, has  contracted,  closed  the  cervical  canal,  and  impris- 
oned the  putrefying  mass.  Therefore  it  is  important  that 
the  uterus  be  relieved  of  necrotic  cotyledons  with  any  at- 
tached fetal  membranes  as  early  as  practicable.  As  in  the 
ordinary  simple  type  of  dehiscence,  the  actual  date  at  which 


576  Diseases  of  the  Genital  Orgayis 

it  is  prudent  to  remove  cotyledons  can  be  determined  only 
by  the  person  in  immediate  charge.  I  attended  a  cow  for 
dystocia  (the  dystocia  of  uterine  inertia)  and  extracted  an 
apparently  healthy  calf.  Forty-eight  hours  later  the  fetal 
membranes  were  completely  retained  and  all  her  cotyledons 
were  enormously  swollen  and  necrotic.  Her  temperature 
was  high  and  her  condition  critical.  All  the  cotyledons  were 
readily  detachable  without  pain  or  hemorrhage.  They  were 
removed  with  the  membranes  still  attached.  The  uterus 
was  then  douched.  Within  twelve  hours  her  temperature 
had  become  normal,  her  recovery  was  prompt,  and  her  fer- 
tility preserved.  This  was  an  extreme  case  cited  to  show 
the  value  of  the  removal  of  necrotic  cotyledons,  when  prop- 
erly done  at  the  right  time.  In  any  other  cow  I  have  at- 
tended, the  removal  of  cotyledons  so  early  after  calving 
would  have  been  wholly  unjustifiable  and  would  have  done 
incalculable  harm.  Each  case  of  retained  fetal  membranes 
constitutes  an  individual  problem,  the  details  of  which  must 
be  worked  out  separately.  Two  principles  regarding  man- 
ual removal  appear  to  me  to  be  applicable  generally.  First, 
whenever  the  membranes  (including  necrotic  cotyledons) 
can  be  removed  completely  without  injury  to  the  uterus, 
this  should  be  done.  Second,  if  the  membranes  can  not  be 
removed  promptly,  measures  should  be  taken  to  delay  the 
contraction  of  the  cervix  and  imprisonment  of  the  putrefy- 
ing tissues.  This  precaution  preferably  consists  of  permit- 
ting or  causing  portions  of  the  membranes  to  occupy  the 
cervical  canal.  When  this  can  not  be  done  there  may  be 
substituted  a  tampon  of  gauze,  which  may  be  made  in  the 
form  of  a  gauze  bag,  two  or  three  feet  long,  the  closed  end 
pushed  into  the  uterine  cavity  and  then  a  suthcient  amount 
of  gauze  pushed  into  the  closed  end  from  the  exterior  to 
produce  an  enlargement  which  will  not  drop  out  through 
the  cervix.  The  presence  of  the  collapsed  portion  of  the  bag 
lying  in  the  cervical  canal  will  retard  cervical  contraction 
and  afford  better  opportunity  for  the  manual  examination 
of  the  uterus.  A  similar  plan  may  be  used  to  dilate  an  al- 
ready contracted  cervix  with  imprisoned  fetal  membranes. 


Puerperal  Diseases  of  the  Uterus  577 

The  closed  end  of  the  bag  may  be  pushed  into  the  uterine 
cavity  with  a  sound,  followed  by  packing  the  bag  through 
the  open  end,  filling  as  well  as  space  will  permit  that  por- 
tion of  the  bag  lying  within  the  cervical  canal.  Prior  to 
application,  the  gauze  should  be  saturated  with  iodoform 
oil  or  vaseline  and  should  be  renewed  daily  until  the  dila- 
tion is  sufficient. 

In  discussing  the  various  types  of  retention  it  has  already 
been  pointed  out  that  the  placentitis  typically  begins  at  the 
cervical  end  of  the  uterus  and  advances  slowly  toward  the 
ovarian  extremity.  The  retention  may  be  in  the  very  early 
stages  and  the  entire  mass  of  membranes  may  readily  be  re- 
moved soon  after  calving  if  the  few  diseased  cotyledons 
about  the  cervical  end  be  manually  released.  Perhaps  my 
meaning  will  be  clearer  by  giving  a  definite  instance.  A 
colleague  in  charge  of  a  valuable  herd  made  it  a  rule  to  ig- 
nore retained  fetal  membranes  until  forty-eight  hours  post 
partum,  when  he  would  make  an  effort  to  remove  manually. 
I  was  asked  incidentally  to  examine  a  cow  which  had 
calved  about  thirty  hours  previously.  I  found  nearly  all  the 
fetal  membranes  detached  and  hanging  from  the  vulva.  A 
careful  examination  revealed  the  fact  that  the  membranes 
were  adherent  to  a  few  cotyledons  at  the  base  of  the  gravid 
horn.  The  dragging  of  the  detached  masses  upon  one  small 
area  had  caused  an  intussusception  of  the  base  of  the  gravid 
horn  and  its  prolapse  through  the  cervix  into  the  vagina. 
It  can  not  be  denied  that  I  was  right  in  detaching  the  few 
adherent  cotyledons  and  replacing  the  prolapsed  organ. 
My  colleague  had  evidently  erred.  The  only  means  for  avoid- 
ing the  error  lay  in  a  careful  examination  of  the  patient. 

The  first  step  in  the  handling  of  retained  fetal  mem- 
branes, as  in  other  diseases,  is  an  early  and  careful  exam- 
ination with  an  accurate  diagnosis.  The  degree  of  uterine 
paresis  is  to  be  noted  carefully  because  it  indicates  more 
than  anything  else  the  probable  severity  of  the  retention. 
If  the  uterus  is  extremely  large  and  flaccid,  the  retention 
will  probably  be  prolonged  and  severe.  If  the  uterus  is  well 
contracted,  firm  and  not  over-sensitive,  the  duration  of  the 

37 


578  Diseases  of  the  Genital  Organs 

retention  will  probably  be  brief  and  the  course  favorable. 
If  the  membranes  can  be  easily  detached  without  causing 
pain  or  irritation  to  the  patient,  their  removal  is  good  sur- 
gery because  it  is  only  after  the  removal  of  the  fetal  mem- 
branes that  one  can  handle  with  any  directness  the  funda- 
mental metritis  which  caused  the  retention.  The  basic  ques- 
tion is  not  the  desirability  of  removing  from  the  uterus  the 
necrotic  membranes,  but  the  possibility  of  removing  them  at 
a  given  date  without  causing  greater  injury  and  danger 
than  the  retention  is  already  producing.  If  not  prudent  to 
attempt  the  removal  at  the  first  examination,  repeat  the  ob- 
servations at  comparatively  frequent  intervals,  at  least 
every  second  or  third  day,  and  watch  the  progress  of  the 
disease. 

Various  plans  have  been  recommended  as  substitutes  for 
the  manual  removal  of  the  membranes,  but  they  have  failed. 
Numerous  drugs  have  been  lauded,  such  as  savin,  rue,  and 
various  aromatic  substances,  but  there  is  no  dependable  evi- 
dence of  their  value.  A  few  years  ago  it  was  proposed  to 
detach  the  membranes  by  injecting  into  the  cavity  of  the 
chorion,  where  the  fetus  formerly  lay,  a  weak  solution  of 
hydrogen  peroxide,  but  it  could  act  only  upon  the  inner  or 
fetal  surface  of  the  chorion  and  could  not  possibly  affect  the 
part  really  at  fault,  as  it  could  not  get  near  it.  Next  some- 
one proposed  to  detach  the  membranes  by  injecting  salt 
solution  into  the  broken  ends  of  the  umbilic  arteries  and 
thence  into  the  capillaries  of  the  incarcerated  chorionic 
tufts,  but  the  promoters  of  the  plan  ignored  the  fact  that 
the  placental  capillaries  were  blocked  by  thrombi  which 
would  not  permit  water  to  enter,  and  equally  disregarded 
the  fact  that  the  physiologic  detachment  of  the  placentae  is 
due,  not  to  distension  of  the  capillaries,  but  on  the  contrary 
to  their  becoming  empty.  If  the  salt  solution  could  be 
forced  into  the  placental  capillaries,  it  would  increase  their 
incarceration. 

Much  has  been  said  for  and  against  douching  the  uterus 
when  the  fetal  membranes  are  retained.  As  a  plain  matter 
of  fact,  so  long  as  the  fetal  membranes  remain  attached  to 


Puerperal  Diseases  of  /he  Uterus  579 

the  cotyledons,  the  uterus  can  not  be  douched  by  any  known 
method.  Fluid  may  be  introduced  into  the  sac  of  the  adher- 
ent chorion  where  the  fetus  formerly  lay,  and  in  some  cases 
may  be  taken  out  again.  The  fluid  does  not  reach  the  uterus 
except  at  points  where  the  membranes  have  become  de- 
tached. The  uterus  is  frequently  too  paretic  to  expel  the 
fluid  poured  into  the  sac  of  the  chorion.  If  the  veterinarian 
attempts  to  siphon  out  the  fluid,  fragments  of  the  amnion, 
chorion  or  umbilic  cord  block  the  siphon.  Some  claim  to 
guard  the  intake  to  the  siphon  with  the  hand,  but  in  a  very 
flaccid  uterus  the  end  of  the  organ  is  out  of  reach  and  the 
hand  can  not  effectively  guard.  For  example,  in  the  ex- 
treme case  of  retained  membranes  following  unicornual 
twins,  if  the  uterus  is  severely  inflamed  it  may  retain  its 
length  of  more  than  eight  feet.  It  is  useless  to  discuss  the 
siphoning  of  fluid  out  of  such  a  uterus.  In  many  cases  fol- 
lowing ordinary  pregnancy,  siphoning  fluid  out  of  the  chori- 
onic sac  is  impracticable.  Even  if  accomplished,  the  opera- 
tion has  very  scant,  if  any  value  to  commend  it. 

If  the  uterus  is  in  such  condition  that  the  vagina  may  be 
douched  without  the  fluid  falling  largely  into  the  paralyzed 
uterus  or  into  the  sac  of  the  chorion  it  contains,  that  may  be 
of  value.  Perhaps  it  is  also  of  value,  when  a  portion  of  the 
uterus  has  been  freed  from  its  membranes,  to  douche  that 
portion,  if  conditions  render  it  practicable.  But  introduc- 
ing quarts  or  gallons  of  liquid  into  the  sac  of  the  retained 
chorion  and  leaving  it  there  is  malpractice.  The  weight  of 
the  fluid  in  the  paretic  organ  does  great  harm.  In  some 
cases  the  uterus  may  be  so  atonic  and  weak  that  the  me- 
chanical weight  of  the  liquid  may  cause  rupture.  The  dan- 
ger of  uterine  rupture  is  greatly  heightened  when  the  opera- 
tor is  so  imprudent  as  to  use  a  pump  for  introducing  the 
fluid,  or  when,  introducing  by  gravity,  he  uses  too  great  a 
column  of  water.  The  danger  is  aggravated  when  the  uterus 
is  very  paretic  and  the  cervix  contracted.  I  have  ruptured 
the  uterus  very  unexpectedly  when  using  the  pump,  al- 
though the  rubber  tube  of  the  pump  passed  the  cervical 
canal  freely  with  abundant  room  about  it.     Just  what  oc- 


580  Diseases  of  the  Genital  Orgayis 

curred  I  could  not  determine.  Either  the  uterus  ruptured 
from  the  weight  of  the  fluid,  the  os  uteri  internum  acted  as 
a  collapsing  valve  and  imprisoned  the  fluid,  or  portions  of 
the  membranes  floated  against  the  cervical  opening  and 
blocked  it.  In  one  instance,  where  the  fetal  membranes,  de- 
tached from  the  uterus,  were  detained  within  the  uterine 
cavity  and  the  cervix  had  contracted  and  would  not  admit 
my  hand,  I  introduced  a  small  amount  of  physiologic  salt 
solution  through  a  rubber  catheter  from  a  hospital  irrigator 
elevated  fifteen  or  twenty  inches.  The  cow  began  to  make 
expulsive  efforts,  the  membranes  blocked  the  cervical  canal, 
and  disaster  followed. 

Arbitrary  rules  for  douching  are  accordingly  unwise.  It 
is  equally  unsound  in  principle  to  condemn  douching  unre- 
servedly. When  the  membranes  are  firmly  retained  and  are 
undergoing  putrefactive  decomposition,  the  cervical  canal 
is  often  very  narrow  and  the  debris  is  imprisoned.  The  ne- 
crotic cotyledons  and  placental  debris  must  be  removed.  If 
one  undertakes  dilation  of  the  cervical  canal,  the  inflamed 
cervix  yields  but  little,  the  force  required  is  great,  and  both 
cervix  and  vagina  are  severely  injured.  The  abrading  and 
stretching  open  important  avenues  for  infection,  the  pain 
causes  straining  and  exhaustion,  and  the  results  are  unsat- 
isfactory. If  the  membranes  are  well  broken  up,  I  have  had 
excellent  results  in  douching  carefully  with  the  large,  single- 
curved  uterine  catheter  shown  in  Fig.  179a.  In  such  cases 
I  use  an  irrigator  elevated  barely  above  the  back  of  the  cow 
and  watch  carefully  for  blocking  of  the  return  flow.  Should 
this  occur,  the  inflow  is  stopped  and  the  catheter  withdrawn. 
It  is  commonly  found  that  the  catheter  is  blocked  by  large 
pieces  of  membranes  or  by  necrotic  cotyledons.  Pieces  of 
moderate  size  can  be  washed  out  with  this  instrument,  but 
it  must  be  used  cautiously.  The  uterus  is  frail  and  the  cath- 
eter is  easily  pushed  through  the  walls.  If  the  animal 
strains  and  pressure  upon  the  catheter  is  felt,  it  must  be 
permitted  to  move  backward,  or  puncture  is  probable.  The 
horse  stomach  tube  may  be  substituted,  but  it  is  not  as 
practical.  The  tube,  especially  the  heavy  type,  is  as  danger- 


Puerperal  Diseases  of  the  Uterus  581 

ous  as  the  metal  catheter  and  must  be  used  as  a  siphon. 
When  this  is  attempted  it  is  quite  as  readily  choked  with 
membranes  and  has  the  additional  disadvantage  of  having 
its  intake  occluded  by  sucking  in  the  uterine  w^all. 

When  the  membranes  are  not  broken  up  and  are  impris- 
oned by  a  contracted  cervix,  douching  is  highly  dangerous 
and  should  not  be  undertaken.  The  cervix  should  be  gently 
dilated  until  portions  of  the  membranes  may  be  grasped 
with  the  hand  or  forceps  and  traction  applied.  If  one-half 
to  one  pint  of  warm  olive  oil  or  liquid  paraffin  is  introduced 
into  the  uterus,  it  lubricates  the  uterine  walls  as  well  as  the 
somewhat  necrotic  tissues  and  favors  removal.  The  oil  also 
soothes  the  irritated  endometrium,  and  in  virtue  of  its  lubri- 
cating action  diminishes  the  epithelial  abrasions  inevitable 
in  such  manipulations. 

Many  cases  occur  where  skilled  veterinary  attendance  at 
the  proper  moment  is  impracticable  or  impossible.  Proper 
veterinary  attendance  upon  retained  fetal  membranes  is 
generally  economically  impossible  in  cows  of  low  value. 
Even  animals  of  great  value  are  frequently  so  located  that 
skilled  veterinary  attendance  is  not  available.  Veterinary 
service  must  then  be  rendered  through  the  layman,  and 
methods  of  handling  which  may  be  quite  proper  when  ad- 
ministered directly  by  the  skilled  practitioner  may  become 
wholly  improper  and  acutely  dangerous  in  the  hands  of  the 
layman.  This  group  includes  at  present  the  majority  of 
cases  of  retained  membranes,  and  their  proper  handling  is 
a  heavy  responsibility  upon  the  veterinary  profession.  Here 
a  hard  and  fast  rule  should  be  laid  down  for  the  layman : 
Bo  not  attempt  the  manual  removal  of  the  fetal  membranes 
or  the  douching  of  the  uterus.  In  numerous  cases  this  rule 
will  work  some  harm.  In  rare  cases,  like  the  one  or  two  ex- 
amples I  have  cited,  it  will  end  in  disaster  when  skillful 
handling  would  have  saved  the  animal.  But  the  peril  to  the 
feiv  is  more  than  counterbalanced  by  avoiding  serious  injury 
to  maiiy.  The  layman  would  probably  fail  in  any  event  in 
those  rather  rare  cases  where  manual  removal  is  imperative. 

At  present  the  best  known  course  for  the  layman  to 


582  Diseases  of  the  (ienital  Organs 

pursue  is  to  introduce  deeply  within  the  chorionic  sac 
a  drug  of  high  specific  gravity,  so  that  it  may  not  be 
thrown  out  readily,  and  slow-dissolving,  so  that  it  will 
not  require  frequent  renewal,  which  will  soothe  rather 
than  irritate  any  portion  of  the  genital  mucosa  with 
which  it  may  come  in  contact  and  which  will  deter  in 
some  measure  the  putrid  decomposition  of  the  mem- 
branes. The  two  best  known  drugs  in  this  group  are 
iodoform  and  bismuth  subnitrate.  To  these  may  be  added 
some  of  the  rapidly-dissolving  disinfectants  of  a  non-irri- 
tating character.  Here  the  limit  is  virtually  set  at  boric 
acid  which  may  be  used  without  restriction.  There  are  two 
methods  of  application.  The  more  convenient  form  is  the 
introduction  of  the  drugs  inclosed  within  gelatin  capsules. 
An  efficient  formula  is  one-half  to  one  ounce  each  of  pow- 
dered iodoform  and  boric  acid,  with  three  to  five  grains  of 
powdered  thymol,  inclosed  in  a  large  gelatin  capsule.  The 
capsules  may  be  prepared  in  large  numbers.  Properly 
wrapped,  they  will  keep  indefinitely,  ready  for  use  when- 
ever needed.  Bismuth  may  be  added  or  may  be  substituted 
for  the  iodoform  or  boric  acid.  When  retained  afterbirth  is 
diagnosed,  one  of  the  capsules  should  be  deposited  as  deeply 
within  the  uterus,  or  rather  in  the  sac  of  the  chorion,  as 
possible.  The  gelatin  quickly  dissolves  and  the  heavy  drug 
drops  to  the  floor  of  the  uterus,  where  it  slowly  dissolves 
during  a  period  of  seven  to  ten  or  more  days.  If  the  reten- 
tion continues,  a  second  capsule  may  be  added  three  to  four 
days  after  the  first.  When  the  membranes  finally  come  away, 
the  drugs  previously  introduced  largely  or  wholly  accom- 
pany them,  and  it  is  desirable  then  to  introduce  another 
capsule,  which  now  comes  into  immediate  contact  with  the 
uterus.  As  this  taints  the  milk  badly,  it  must  on  no  account 
be  included  in  market  milk  or  used  for  making  butter  or 
cheese.  Tasting  the  milk  carefully  is  the  only  guide  as  to 
when  it  is  fit  to  market.  It  is  perfectly  healthful  and  may 
be  used  freely  for  feeding  calves.  The  intelligent  layman 
can  readily  learn  to  introduce  the  capsule.  The  tail,  vulva 
and  buttocks  of  the  cow  should  first  be  washed  and  disin- 


Puerperal  Diseases  of  the  Uterxis  58 

fected.  The  operator  should  trim  his  finger  nails  closely 
and  smoothly  and  disinfect  and  soften  his  hands  in  a  warm 
disinfecting  solution.  The  disinfectant  may  then  be  rinsed 
off  the  hand  with  warm  water  and  the  capsule,  inclosed 
within  the  hand,  carried  deeply  into  the  sac  of  the  fetal 
membranes  and  dropped  there. 

A  method  which  is  certainly  more  efficient  in  many,  and 
possibly  in  most  cases  is  the  introduction  of  the  iodoform  or 
other  drug  suspended  in  a  neutral  oil.  Liquid  paraffin  is 
probably  in  all  respects  the  preferable  medium.  The  drug  is 
to  be  placed  in  a  pint  or  quart  bottle,  the  vessel  filled  with 
the  oil,  and  then  shaken  until  well  suspended.  It  is  then  to 
be  poured  into  a  hospital  irrigator  with  the  seven-foot  rub- 
ber catheter  designed  for  douching  bulls  attached,  the  end 
of  the  catheter  carried  by  the  hand  and  held  as  deeply  within 
the  cavity  as  can  be  reached,  the  irrigator  elevated  two  or 
three  feet  above  the  uterus,  and  the  contents  allowed  to  flow 
in.  The  heavy  drug  falls  down  upon  the  floor  of  the  uterus, 
as  with  the  capsule,  while  the  oil  floats  upon  other  liquids 
which  may  be  present  and  comes  in  contact  with  and  soothes 
any  portions  of  the  inflamed  genital  mucosa  which  may  be 
uncovered.  It  is  more  trouble  to  prepare  and  apply,  and 
the  average  layman  is  more  liable  to  make  some  mistake  in 
the  handling  of  the  iodoform  and  taint  the  milk  from  cows 
other  than  the  one  diseased. 

The  plan  just  described  should  also  occupy  a  lai*ge  place  in 
the  handling  of  retained  fetal  membranes  by  the  skilled  vet- 
erinarian. In  all  those  cases  where  at  the  time  of  examina- 
tion it  is  not  feasible  to  remove  the  membranes  manually, 
the  iodoform  capsule  or  the  introduction  of  an  iodoform  sus- 
pension in  oil  or  liquid  paraffin  constitutes  the  best  line  of 
treatment  at  present  known. 

In  practice  one  occasionally  encounters  retained  placenta 
in  which  the  underlying  metritis  is  of  a  highly  irritable  type 
and  the  cow  evinces  much  pain  by  constant  and  violent 
straining.  In  rare  cases  this  is  due  to  intussusception  of  the 
ovarian  end  of  the  gravid  horn,  which  may  eventually  end 
in  uterine  prolapse,  or  may  telescope  for  a  few  inches,  be- 


584  Diseases  of  the  Creniial  Organs 

come  incarcerated  there  and  remain  persistently.  This 
should  be  searched  for  when  such  symptoms  are  present 
and,  if  discovered,  reduced  by  gentle  pressure  against  it 
with  the  hand.  It  is  not  essential  to  take  away  the  mem- 
branes. It  is  far  more  important  to  reduce  the  intussuscep- 
tion and  soothe  the  irritated  uterus  with  oleaginous  suspen- 
sion of  iodoform.  Metritis  with  retained  afterbirth,  accom- 
panied by  great  pain  and  straining,  is  most  frequently  ob- 
served after  imprudent  attempts  at  the  removal  of  the  mem- 
branes. It  is  believed  by  many  that  in  such  cases  the  after- 
birth yyiust  be  removed  at  any  cost.  The  opposite  is  more 
nearly  correct :  the  membranes  should  be  left  strictly  alone 
and  the  irritated  uterus  soothed  with  iodoform-oil  or  other- 
wise. 

Once  the  retained  fetal  membranes  have  been  taken,  or 
have  come  away,  the  original  disease  which  caused  it  is  still 
present.  The  important  change  in  conditions  is  that  the 
uterus  is  now  naked  and  curative  measures  directly  appli- 
cable. The  uterus  may  then  be,  and  as  a  rule  should  be, 
douched  in  order  to  clear  away  any  exudate  or  remaining 
debris.  The  condition  now  facing  the  veterinarian  is  simple 
metritis,  and  the  method  of  handling  is  the  same  as  though 
the  retention  of  the  membranes  had  not  occurred. 

The  prevention  of  retained  fetal  membranes  can  be  ac- 
complished only  by  seeing  that  a  cow  at  breeding  time  has  a 
clean  uterus  and  cervix,  and  that  she  is  bred  to  a  bull  free 
from  important  infection.  These  matters  are  discussed  in 
their  proper  places. 

E.  Puerperal  Tetanus. 
Immediately  following  parturition  the  denuded  endome- 
trium opens  an  avenue  for  the  invasion  of  specific  infections 
not  commonly  entering  by  the  genital  tract.  Tetanus  infec- 
tion occasionally  invades  the  genital  organs  at  this  time  and 
produces  the  ordinary  clinical  symptoms  of  that  disease.  I 
have  observed  it  but  once  in  the  cow,  associated  with  re- 
tained fetal  membranes.  It  offers  nothing  special  except 
that  a  knowledge  of  the  possibility  makes  even   more  do- 


Puerperal  Laminitis  585 

sirable  comprehensive  precautions  against  the  entrance  of 
any  form  of  infection  from  the  exterior  through  the  vulva. 
The  protrusion  of  the  fetal  membranes  from  the  vulva  in- 
creases when  the  patient  is  recumbent,  and  when  she  rises 
they  are  drawn  back  somewhat  and  may  drag  into  the  vagina 
infections  caught  by  the  protruding  membranes.  Tetanus 
infection  is  also  possible  when  a  prolapsed  uterus  comes  in 
contact  with  stable  manure. 

F.  Puerperal  Laminitis. 

Puerperal  laminitis  is  virtually  constant  in  endometritis 
in  the  mare,  but  I  have  observed  only  one  instance  in  the 
cow.  The  symptoms  of  puerperal  laminitis  in  the  cow  are 
the  same  as  those  of  the  laminitis  of  indigestion  and  of  the 
corresponding  disease  in  horses.  It  is  quite  unnecessary  to 
describe  the  symptoms  and  course  of  the  disease  here,  but 
it  is  important  to  bear  in  mind  that  puerperal  laminitis  is 
due  to  the  presence  of  an  endometritis  instead  of  an  irrita- 
tion in  the  intestinal  tract. 

In  handling  puerperal  laminitis  in  the  cow  the  funda- 
mental factor  is  the  proper  alleviation  of  the  underlying  en- 
dometritis by  the  means  already  advised  for  that  disease. 
In  addition  to  these  measures,  the  veterinarian  should  give 
necessary  attention  to  the  feet,  either  by  standing  the  ani- 
mal in  cold  water  or  by  applying  ice  bags. 

G.  Puerperal  Meningitis 

Puerperal  meningitis  has  found  no  recognized  place  in 
veterinary  literature.  I  have  observed  one  instance  only. 
The  patient  was  a  young  cow  in  a  herd  reeking  with  genital 
infections.  She  calved  without  notable  incident  and  ap- 
peared to  be  progressing  favorably  for  about  two  days, 
when  she  suddenly  developed  symptoms  of  severe  menin- 
gitis. The  patient  was  exceedingly  uneasy,  with  constant 
muscular  twitchings.  The  head  was  held  erect  and  the  gait 
was  rigid  and  uncertain.  She  was  readily  disturbed,  as  in 
tetanus.  The  course  was  stormy  and  death  occurred  within 
one  day.    Autopsy  showed  intense  injection  of  the  meninges 


586  Diseases  of  the  Cicnital  Orj^atis 

without  very  marked  uterine  lesions.  There  is  little  or  noth- 
ing to  be  done  for  puerperal  meningitis.  It  apparently  sig- 
nifies that  a  metastasis  from  the  infected  genital  tract  has 
occurred  and  the  matter  has  already  largely  passed  beyond 
control  before  clinical  warning  has  been  given.  Chloral  or 
narcotics  might  be  used  to  quiet  the  patient  and  an  effort  to 
counteract  the  infection  may  be  made  with  ounce  doses  of 
formalin  or  with  other  agents  which  tend  to  act  as  systemic 
disinfectants. 

There  is  little  limit  to  the  metastases  which  may  occur 
during  the  puerperium.  Infections  of  the  pregnant  uterus 
are  so  common,  and  the  endometrium  is  so  largely  denuded 
at  parturition  that  the  intra-uterine  infections  have  an  un- 
usually favorable  opportunity  to  reach  the  lymph  or  blood 
stream  and  be  borne  to  any  organ  or  tissue  in  the  body.  The 
infection  may  lodge  in  the  liver,  lungs,  joints,  or  in  any  or- 
gan or  tissue,  and  there  produce  symptoms  of  disease  wholly 
unsuggestive  of  genital  origin  unless  the  observer  is  fully 
cognizant  of  the  possibilities  and  is  on  the  alert. 

5.    Post-Puerperal  Infections  of  the  Uterus 

After  the  puerperal  period,  which  may  be  regarded  ordi- 
narily as  comprising  ten  to  fifteen  days,  there  follows  ideally 
in  cows  an  interval  of  sixty  to  ninety  days  before  it  is  de- 
sirable to  breed  them  again.  In  approximately  ninety  per 
cent,  of  cows,  rebreeding  is  delayed  beyond  ninety  days  be- 
cause of  disease  or  for  other  reasons,  and  the  period  is  yet 
further  prolonged  in  many  cows  by  their  failure  to  conceive 
when  bred.  During  this  interval  infinite  changes  in  the  in- 
tra-uterine infections  may  occur.  Historically  most  of  the 
uterine  infections  of  the  post-puerperal  epoch  are  continua- 
tions of  infections  which  have  persisted  through  pregnancy 
and  the  puerperal  period  and  have  been  modified  in  their  in- 
tensity and  behaviour  by  the  changes  in  environment. 
Sometimes  the  infections  of  the  puerperal  period  advance  in 
intensity  in  the  post-puerperal  era.  In  many  instances  there 
is  a  strong  reaction  to  the  infection  present  and  recovery, 
entire  or  partial,  often  occurs.   Thus  many  cows  which  had 


I 


Post- Puerperal  Uteriyie  Infections  587 

during  pregnancy  so  severe  an  infection  that  it  caused  abor- 
tion, and  during  the  puerperium  outstanding  metritis,  so 
far  recover  that  they  again  conceive  and  successfully  pass 
through  pregnancy.  On  the  other  hand  the  infection  is 
often  so  mild  that  an  apparently  healthy  calf  is  born  and  no 
external  evidences  of  puerperal  disease  follow.  But  when 
it  is  attempted  to  breed  such  a  cow  again,  she  may  be  tempo- 
rarily or  permanently  sterile,  or,  having  conceived,  may 
abort  owing  to  the  fact  that,  during  the  period  when  many 
cows  are  overcoming  infection,  her  uterus  has  been  over- 
come by  the  infection. 

The  puerperal  period  is  a  critical  time  in  the  breeding  his- 
tory of  a  cow.  It  is  one  of  the  most  important  and  favorable 
periods  in  the  life  of  a  cow  in  which  to  attack  successfully 
genital  infections,  and  the  chief  aim  of  the  practitioner 
should  be  to  deal  energetically  with  the  infections  during  the 
puerperium  and  not  to  permit  them  to  drag  along  into  the 
post-puerperal  stage.  For  example,  since  retained  after- 
birth is  generally  handled  simply  and  wholly  as  "retained 
afterbirth",  as  soon  as  the  membranes  are  out  of  the  uterus 
the  ignorant  or  careless  veterinarian  thinks  of  his  task  as 
completed  and  allows  the  fundamental  metritis  to  persist 
into  the  post-puerperal  period.  Then  he  faces  the  difficult 
problem  of  handling  chronic  endometritis  or  pyometra,  and 
perhaps  fails  to  restore  the  reproductive  life  of  the  animal, 
thus  occasioning  irretrievable  loss.  It  is  clearly  an  error  in 
professional  duty  to  permit  avoidably  the  metritis  of  re- 
tained fetal  membranes  to  continue  into  the  post-puerperal 
period. 

In  the  post-puerperal  period  new  infection  may  invade 
the  uterus  from  without.  There  is  nothing  to  show  that  there 
is  great  danger  of  any  infection  invading  the  uterus  during 
this  period  as  a  result  of  ordinary  cohabitation.  That  is, 
there  is  no  conclusive  evidence  that  the  presence  of  a  cow 
which  has  recently  aborted,  has  retained  afterbirth,  or  is 
suffering  from  other  disastrous  type  of  genital  infection  has 
any  great  or  recognizable  peril  for  non-pregnant  contact 
cows.    There  is  no  evidence  that  harm  comes  to  a  healthy 


588  Diseases  of  the  Genital  Organs 

non-pregnant  cow  through  eating  food  or  drinking  water 
contaminated  by  genital  discharges  from  a  diseased  animal. 
It  has  not  been  shown  that  infections  discharged  from  the 
genital  tract  of  a  diseased  cow  will  traverse  the  vulva  and 
vagina  of  a  contiguous  healthy  cow  and  cause  intra-uterine 
disease. 

There  is  abundant  clinical  evidence  that  an  infected  bull 
is  competent  to  transmit  infection  to  the  uterus  of  a  healthy 
cow  during  coitus  and  either  establish  a  disease  (cervicitis, 
metritis,  salpingitis)  which  inhibits  conception,  or  when  the 
infection  is  less  mild,  establish  disease  within  the  pregnant 
uterus  to  end  finally  in  abortion  or  other  disaster. 

It  has  apparently  been  shown  experimentally  that  serious 
uterine  or  other  genital  infection  may  be  established  in 
healthy  non-pregnant  animals  by  introducing  into  the  blood 
stream  or  into  the  subcutaneous  tissue,  and  thence  indirectly 
into  the  blood  stream,  pathogenic  bacteria  having  an  affinity 
for  the  genital  organs.  Thus  the  experiments  of  Bland'  have 
apparently  shown  that  by  injecting  large  doses  of  B.  abortus 
cultures  into  non-pregnant  cows  and  heifers  the  fertility  of 
the  latter  is  seriously  lowered,  that  a  large  percentage  of  the 
animals  fails  thereafter  to  conceive,  or,  if  they  conceive,  the 
embryo  is  absorbed  or  expelled  unseen.  This  may  be  appar- 
ent only,  since  the  experiments  were  entirely  too  inaccurate 
to  aff"ord  a  secure  basis  for  judgment.  If  the  experiments 
actually  caused  the  apparent  harm,  it  may  have  been  di- 
rectly by  the  B.  abortus  reaching  the  genital  canal,  or  indi- 
rectly through  lowering  the  resistance  of  the  patient  to  or- 
ganisms already  resident  in  the  genital  tract.  In  studying 
the  infections  of  the  uterus  during  the  post-puerperal  period, 
it  is  important  to  bear  in  mind  their  various  possible  or 
probable  sources,  because  evidently  the  prophylaxis  of  the 
various  types  of  disease  occurring  during  this  period  must 
depend  upon  the  power  or  desire  to  eliminate  the  dangerous 
infections  existing  during  the  puerperal  period,  and  to 
avoid  coital  infection  by  excluding  seriously  diseased  bulls. 

The  variety  of  organisms  which  may  cause  disease  of  the 

'Second  Report  on  the  Epizootic  Abortion  Experiments,  1911-1916. 


Endometritis  589 

non-gravid  uterus  is  infinite.  Any  organism  competent  to 
cause  wound  infection  may  injuriously  attack  the  uterus. 
A  long  list  of  bacteria  has  been  described  as  the  causes  of 
various  uterine  diseases.  Perhaps  the  Streptococcus  viri- 
dans  is  the  most  common  and  most  destructive,  but  colon- 
like bacilli,  B.  pyogenes,  staphylococci,  and  micrococci  are 
common.  The  B.  abortus  is  apparently  a  common  resident 
of  the  uterus  during  the  puerperal  period  but,  according  to 
most  bacteriologists,  disappears  early  after  the  close  of  preg- 
nancy. In  the  following  discussion  of  the  uterine  infections 
of  this  period,  explicit  reference  to  the  biology  will  not  be 
attempted  because  the  present  knowledge  of  the  subject  does 
not  warrant  it.  The  classification  is  arbitrary  and  merely 
intended  to  aid  in  arriving  at  reliable  diagnoses  and  prog- 
noses. The  classes  merge  by  imperceptible  gradations  one 
into  another. 

A.  Endometritis 

The  typically  healthy  uterus  passes  imperceptibly  into  the 
simplest  type  of  metritis.  The  imperceptible  line  of  demar- 
cation between  health  and  disease  is  as  impossible  to  fix  in 
the  non-gravid  as  in  the  gravid  uterus.  As  previously 
stated,  there  is  almost  always  sufficient  infection  present  in 
the  apices  of  the  uterine  horns  to  cause  a  definite  necrosis  of 
the  contiguous  tips  of  the  embryonic  sac.  It  may  be  of  suf- 
ficient virulence  to  cause  necrosis  of  the  entire  non-gravid 
horn  of  the  fetal  sac.  But  it  may  not  cause  disease  so  far 
as  any  marked  peril  to  the  embryo  is  concerned. 

Clinically  the  non-gravid  uterus  physiologically  runs  such 
a  gamut  that  it  is  sometimes  perplexing.  For  some  days 
prior  to  estrum  the  uterus  becomes  increasingly  engorged, 
until  finally,  when  estrum  is  fully  developed,  the  healthy 
uterus  is  enlarged  to  approximately  double  its  size  when  at 
rest.  After  the  ovisac  ruptures,  the  engorgement  slowly 
subsides  and  the  uterus  regains  its  typical  character  of  the 
inter-estrual  pause.  The  secretions  change  also.  With  the 
advent  of  estrual  engorgement  there  is  an  increased  secre- 
tion of  mucus,  but  not  notable.    Most  of  the  mucus  of  estrum 


590 


Diseases  of  the  Genital  Organs 


emanates  from  the  cervix— not  from  the  uterus.     Shortly 
after  ovulation,  if  conception  does  not  occur,  hemorrhage 
ensues  from  the  cotyledons  (menstruation)  which  in  pass- 
ing out  becomes  incorporated  with  the  mucus  of  the  cervix. 
The  gradually  increasing  estrual  engorgement  requires  two 
to  four  days  for  its  maximum  development  and  a  similar 
period  for  its  decline,  so  that  of  the  twenty-one  days  usually 
constituting  the  estrual  cycle,  the  uterus  is  engorged  in  vary- 
ing degrees  approximately  one-third  of  the  time,  and  dur- 
ing no  two  days  is  the  engorgement  the  same.    So  it  is  with 
infection.    Bacteria  may  be  present — commonly  are  present 
— in  considerable  numbers  without  causing  recognizable  dis- 
ease.   The  infection  rarely  remains  static,  but  either  ad- 
vances to  cause  disease  or  is  almost  or  wholly  overpowered 
by  the  uterus.     After  a  heifer  has  failed  to  conceive,  until 
three  years  old  or  less,  her  uterus  slowly  loses  its  tone,  en- 
larges and  becomes  flabby.  The  same  rule  applies  to  the  post- 
puerperal  uterus.    If  the  cow  fails  to  conceive  with  reason- 
able promptness,  the  organ  loses  its  tone  (if  it  had  recov- 
ered its  tone  during  the  puerperal  era) ,  enlarges,  becomes 
flaccid,  and  drops  far  forward  in  the  abdomen.     Endome- 
tritis becomes  recognizable  by  the  atony  and  the  enlarge- 
ment.  By  catheterization  there  is  shown  to  be  present  in  the 
uterus  muco-pus  or,  in  the  milder  forms,  mucus.   The  endo- 
metritis may  be  due  to  infection  extending  from  the  cervix, 
possibly  originally  coming  from  the  bull  through  coitus,  or, 
as  most  frequently  occurs,  persisting  in  the  uterus  from  the 
puerperal  period.    The  chief  cause  may  reside  outside  the 
uterus.    Thus  in  nymphomania,  while  the  disease  is  pri- 
marily ovarian,  due  to  a  peculiar  type  of  cystic  degenera- 
tion, endometritis  is  a  constant  result  of  the  ovarian  dis- 
ease.   Clearly  the  metritis  needs  to  be  referred  finally  to  the 
presence  of  bacteria  in  the  uterus,  but  the  ovarian  disease 
so  disturbs  the  genital  system  as  a  whole  that  existing  in- 
fections which  would  otherwise  be  held  under  control  gain 
in  virulence  and  cause  harm. 

The  clinical  evidence  of  endometritis  is  the  recognizable 
enlargement  of  the  uterus.     Palpated  per  rectum,  the  uter- 


Endometritis  591 

ine  horns,  enlarged  transversely,  elongated,  and  flabby,  fall 
over  the  pubic  brim  to  lie  upon  the  abdominal  floor.  In  this 
manner  they  drag  the  ovaries  downward  and  forward.  The 
mesometrium  loses  its  tone  also  and  the  entire  genital  group 
hangs  flabbily  from  the  vulva.  If  the  uterus  is  douched, 
there  returns  in  the  fluid  in  many  cases  some  mucus  or  muco- 
pus.  In  the  abattoir  such  a  uterus  is  eighteen  to  twenty- 
four  or  more  inches  long  upon  its  greater  curvature.  Its 
interior  contains  a  little  mucus  streaked  more  or  less  notably 
with  pus.  The  uterine  mucosa  is  thickened,  turgid,  and  en- 
gorged. Endometritis  passes  imperceptibly  into  pyometra. 
Frequently  there  is  found  in  an  otherwise  apparently  healthy 
uterus  a  few  mils  of  pus  somewhat  mixed  with  mucus.  In 
other  cases  larger  amounts  of  pus  are  encountered,  until 
finally  the  pus  content  is  of  such  volume  that  the  disease  is 
described  as  pyometra. 

Endometritis  of  moderate  degree  is  not  readily  recogniza- 
ble during  estrum.  At  that  time  the  flabby  uterus  partly 
regains  its  tone  and  there  is  a  flood  of  mucus  which  tempo- 
rarily conceals  evidences  of  disease.  Endometritis  is  largely 
associated  with  cervicitis  at  the  vaginal  end  of  the  uterus, 
and  with  salpingitis  or  ovaritis  or  both  at  the  ovarian  end. 
That  is,  intra-uterine  infection  cannot  readily  be  confined  to 
the  uterus  for  a  long  period  of  time.  Since  the  tube  is  con- 
tinuous, the  infection  tends  to  pass  from  the  uterus  into  the 
cervix  and  the  oviduct. 

The  prognosis  of  endometritis  in  itself  is  good.  When 
proper  handling  is  delayed  and  salpingitis  has  resulted,  the 
latter  is  virtually  beyond  control.  So  long  as  the  endome- 
trium preserves  its  integrity,  endometritis  is  generally  reme- 
diable. While  technically  a  mucous  membrane  can  not  be 
disinfected  without  destruction,  clinically  the  uterine  mucosa 
can  be  rendered  sterile  or  essentially  so.  In  my  experience 
it  has  been  not  only  possible  but  quite  practicable  to  disin- 
fect the  uterine  cavity  so  far  that,  if  the  animal  is  slaugh- 
tered ten  to  fifteen  days  later,  attempts  to  grow  cultures 
from  the  uterine  mucosa  fail,  while  similar  efi'orts  with  the 
oviducts,  which  are  beyond  surgical  reach,  yield  bacterial 
growths. 


592  Diseases  of  the  Genital  Organs 

The  handling  of  endometritis  may  be  direct  or  indirect. 
The  direct  treatment  consists  fundamentally  of  douching 
the  cavity  with  suitable  disinfecting  fluids  and  introducing 
into  the  uterus  slow-dissolving  agents  which  may  serve  to 
repress  bacterial  growth.  In  my  experience  the  compound 
solution  of  iodine  (Lugol's  solution)  in  a  strength  of  one 
to  two  per  cent,  has  yielded  satisfactory  results.  The  uterus 
has  a  high  tolerance  for  the  drug  (experimentally  I  have 
used  a  ten  per  cent,  solution)  and  it  does  not  coagulate  mu- 
cus. Its  color  is  such  that  muco-pus,  when  douched  out  in 
the  fluid,  is  readily  observed  as  are  most  kinds  of  exudate 
occurring  within  the  uterus.  Some  have  advised  instead  a 
physiologic  salt  or  soda  bicarbonate  solution,  contending 
that  the  mechanical  douching  out  of  the  infection  is  prefer- 
able to  the  use  of  a  disinfectant.  I  can  not  agree  with  this. 
Very  good  authorities  claim  that,  in  douching  the  uterus  of 
a  woman,  the  fluid  may  force  its  way  through  the  oviducts 
to  the  peritoneal  cavity.  Possibly  anaesthesia  favors  such 
penetration.  I  have  no  reason  to  believe  that  any  material 
peril  of  forcing  the  oviducts  accompanies  the  douching  of 
the  bovine  uterus,  but  the  danger  may  be  far  greater  than  I 
have  suspected.  In  case  of  danger  a  neutral  solution  has  by 
far  the  greater  peril  because  of  its  tendency  to  push  the  in- 
fection undamaged  into  the  oviducts  and  set  up  salpingitis. 

There  is  always  present  the  danger  of  puncturing  the 
uterus  with  the  catheter.  When  this  occurs,  a  few  ounces 
of  Lugol's  solution  injected  into  the  peritoneal  cavity  irri- 
tate the  peritoneum,  there  is  quickly  thrown  out  an  abun- 
dance of  serum  which  dilutes  the  fluid,  and  it  is  soon  re- 
sorbed.  If  some  infection  is  pushed  into  the  peritoneal 
cavity,  Lugol's  solution  tends  to  neutralize  it.  but  when  a 
salt  or  soda  solution  is  used  the  infection  acts  unhindered. 
I  consider  that  in  all  respects  it  is  much  safer  to  use  a  re- 
liable disinfectant  rather  than  neutral  fluids  when  douch- 
ing the  post-puerperal  uterus. 

I  have  used  other  disinfectants,  but  have  not  seen  my  way 
to  adopt  them.  Dakin's  solution  and  similar  chlorine-bear- 
ing solutions  have  been  tried  but  need  to  be  used  in  very 


Endometritis  593 

weak  solution  and  with  great  care.  Phenol  compounds  are 
generally  too  irritant.  The  sulphates  of  copper,  zinc,  and 
iron  coagulate  mucus  too  promptly. 

Of  the  slow-dissolving  agents,  iodoform  and  bismuth  are 
best  known  and  render  good  service  in  many  cases.  Sus- 
pended in  oil,  either  or  both  may  be  introduced  in  a  variety 
of  ways.  The  uterine  syringe  shown  in  Fig.  196  is  a  very 
convenient  instrument.  By  using  the  conical  nozzle,  the  end 
may  be  pushed  into  the  opening  of  the  uterine  catheter  and 
the  suspension  injected  through  it;  by  using  the  long  curved 
nozzle,  the  mixture  may  be  readily  injected  directly  into  the 
uterine  cavity. 

As  a  rule  the  treatment  for  endometritis  should  not  be 
repeated  until  two  or  three  weeks  have  elapsed.  When  im- 
portant disease  exists  in  other  parts  of  the  genital  system, 
it  should  be  handled  vigorously  along  with  the  endometri- 
tis. Thus,  if  nymphomania  is  present,  no  degree  of  atten- 
tion to  the  uterus  alone  will  give  relief.  The  cystic  disease 
of  the  ovaries  should  receive  first  attention,  accompanied 
by  the  proper  handling  of  the  uterus.  Professor  Hess  has 
also  pointed  out  that  dislodging  a  retained  corpus  luteum 
arouses  physiologic  function  of  the  entire  genital  system. 
But  that  does  not  mean  to  press  out  the  corpus  luteum  when- 
ever found  in  connection  with  endometritis.  If  the  cow  is 
regular  in  estrum  or  fairly  so,  the  corpus  luteum  should  be 
let  alone,  but  when  the  corpus  luteum  has  persisted  for 
many  weeks  and  inhibited  estrum  it  should  be  pressed  out, 
so  that  its  inhibitory  power  is  brought  to  a  close  and  estrum 
will  ensue.  With  estrum  the  uterus  becomes  physiologically 
active,  tending  thereby  to  disinfect  its  cavity. 

An  animal  having  endometritis  should  not  be  permitted  to 
copulate.  Coitus  increases  the  endometritis,  endangers  the 
bull,  and  generally  prevents  conception.  Should  conception 
follow,  the  pregnancy  is  unsafe  and  may  terminate  in  abor- 
tion, premature  birth,  retained  fetal  membranes,  or  other 
disaster. 
38 


594  Diseases  of  the  Cenital  Orgayis 

B.  Pyometra. 

When  pus  in  large  volume  is  retained  within  the  uterus, 
the  condition  is  designated  pyometra.  It  passes  by  scarcely 
discernible  gradations  on  the  one  hand  into  endometritis, 
and  upon  the  other  into  sclerotic  metritis.  Pyometra  is 
used  to  designate  not  only  the  amount  of  pus  formed  within 
the  uterus  but  also  the  approximate  degree  of  uterine  atony 
and  hence  the  extent  of  retention  of  the  pus  within  the  uter- 
ine cavity.  There  may  be  a  considerable  volume  of  pus 
formed  within  the  uterus,  but  the  muscular  coat  retains  its 
function  and  almost  immediately  expels  it  into  the  vagina. 
One  frequently  encounters  several  ounces  of  pus  in  the  va- 
gina, but  upon  douching  the  uterus  finds  but  little  within 
that  cavity.  After  making  proper  allowance  for  such  pus 
as  may  have  been  formed  in  the  cervix  or  in  the  vagina 
itself,  the  volume  within  the  uterus  compared  with  that  in 
the  vagina  expresses  approximately  the  general  tonicity  of 
the  uterus  and  the  extent  of  involvement  of  its  various  tis- 
sues. If  the  pus  lies  almost  entirely  within  the  vagina,  it 
indicates  that  the  disease  is  limited  chiefly  to  the  uterine 
mucosa  or  endometrium  and  may  therefore  be  designated 
endometritis.  If,  however,  there  is  comparatively  little  pus 
encountered  in  the  vagina,  but  most  of  it  is  retained  within 
the  uterus,  it  is  more  appropriately  designated  pyometra. 

The  chief  symptom  of  pyometra  is  the  presence  of  a  puru- 
lent discharge  from  the  vulva.  The  discharge  may  be  pro- 
fuse or  scant,  and  in  exceptional  cases  may  be  absent.  A 
discharge  issuing  from  the  vulva  may  emanate,  aside  from 
the  uterus,  from  the  cervix,  vagina,  urinary  bladder  (and 
through  the  bladder,  from  the  kidney),  and  from  other 
sources.  The  pus  discharged  may  vary  infinitely  in  charac- 
ter. It  is  usually  fetid,  often  extremely  so.  It  is  generally 
yellowish-white  and  thick.  The  pus  of  pyometra,  as  the 
term  is  commonly  applied,  is  not  ordinarily  mixed  with 
recognizable  mucus  because  suppuration  has  supplanted 
the  formation  of  mucus  in  the  mucous  glands  of  the  uterus. 
In  endometritis  the  mucus-secreting  power  of  the  uterus  is 
deranged  but  not  destroyed.    In  some  old  cases  the  heavier 


Pyometra 


595 


parts  of  the  pus  are  precipitated  in  the  lower  portions  of 
the  uterine  horns  while  the  more  liquid  parts  escape  through 
the  cervix  and  vulva.  Thus  there  is  formed  a  very  dense,  in- 
tensely fetid,  cheesy  mass. 

The  discharge  of  pus  may  be  constant  or  intermittent. 
This  is  dependent  chiefly  upon  the  degree  of  atony  in  the 
uterine  walls  and  the  obstruction  offered  by  the  cervix. 
The  pus  from  the  uterus,  passing  over  the  cervical  mucosa, 
inevitably  causes  cervicitis,  which  in  turn  aggravates  the 


Fig.  184 — Pyometra  with  Granular  Mucosa. 

U,  Uterine  wall  ;    M,  mucosa  coarsely  granular  or  nodular;     C,  cotyledon. 

pyometra.  The  effect  upon  the  cervix  varies.  Sometimes 
the  cervix  becomes  atonic  and  flabby  with  its  canal  dilated. 
The  pus  then  escapes  freely  from  the  uterus  whenever  the 
uterine  walls  contract,  or  whenever  the  uterus  is  com- 
pressed by  contiguous  viscera  while  the  cow  is  recumbent. 
In  these  cases  there  is  often  an  escape  of  a  large  volume  of 
pus  each  time  the  animal  lies  down.  When  on  the  contrary 
the  cervix  retains  its  muscular  energy  or,  as  shown  in  Fig. 
185,  extensive  cervical  sclerosis  is  present,  the  pus  is  re- 


596  Diseases  of  the  Cenital  Organs 

tained  in  the  uterus  until  such  time  as  the  intra-uterine 
tension  suffices  to  dilate  the  cervical  canal,  when  the  pus  is 
expelled  in  large  volume,  succeeding  which  days  or  weeks 
may  pass  without  purulent  discharge.  During  the  post- 
puerperal  period,  as  clinically  designated,  there  may  occur 
pregnancy,  the  embryo  or  letus  may  perish  and  be  retained 
and,  as  described  under  "The  Infections  of  the  Gravid  Uter- 
us", there  may  be  established  a  persistent  pyometra  and  the 
pus  may  be  mixed  with  blood.    In  rare  cases  very  extensive 


Fi(^    185— Pyometra.     Median   Section   through  Rig-ht  Cornu.     Cow. 

/,    Cervix  with  sclerotic  walls  ;    2,  utero  cornual  cavity 
sliowinj^  nodular  luucosa. 

pyometra  occurs  without  visible  discharge.  The  uterus  is 
completely  flaccid  and  paretic.  It  drops  far  forward  into 
the  abdominal  cavity  and  may  lead  to  error  in  diagnosis,  be- 
ing mistaken  for  pregnancy. 

The  diagnosis  of  pyometra  is  usually  simple.  Upon  in- 
spection the  vulva,  tail  and  buttocks  are  soiled  with  pus. 
If  the  animal  is  recumbent  there  is  often  a  tell-tale  mass  of 
pus  lying  behind  her.  Vaginal  exploration  generally  reveals 
fetid  pus  in  its  cervical  end.  Rectal  palpation  discloses  a 
distended,  flabby  uterus,  usually  with  thickened  walls.  The 
two  horns  are  generally  similarly  but  not  identically  filled. 


Pyo7netra  597 

and  the  contents  may  be  pressed  from  the  one  into  the  other 
horn.  The  contents  are  clearly  less  fluid  than  lymph  or 
mucus  and  are  not  at  all  like  the  fetal  fluids.  The  uterus  is 
wholly  wanting  in  the  tone  of  pregnancy,  no  cotyledons  are 
present,  and  the  uterine  arteries  are  not  materially  in- 
creased in  volume. 

The  accuracy  of  the  physical  examination  is  greatly  in- 
creased by  the  application  of  traction  through  forceps  fixed 
upon  the  vaginal  portion  of  the  cervix.    This  brings  the 


Fig.    1 86 — Pyometra. 

/,  Vagina ;    2,  cervix  ;    j,  coniual  cavity  filled  with  pus  ;    4,  central  corpus 

luteum  of  pyometra;  5  (insert)  corpus  luteum  of  pregnancy. 

flabby  uterus  into  or  near  to  the  pelvis  and  tenses  it  in  a 
manner  which  facilitates  proper  palpation. 

The  diagnosis  is  to  be  completed  finally  by  douching  the 
uterus.  If  the  case  is  exceedingly  complex  or  the  examiner 
unfamiliar  with  the  disease,  he  should  be  on  the  alert  re- 
garding the  presence  of  a  uterine  seal.  If  this  appears  to 
be  present,  he  should  study  the  case  more  in  detail  by  rectal 
exploration.  He  must  not  accept  the  history  given  by  the 
owner  that  the  animal  has  not  been  bred  since  the  termina- 
tion of  a  prior  stated  pregnancy.  Owners,  however  care- 
ful, do  not  always  know.  The  veterinarian  must  accept  the 
history  given  by  the  owner  so  long  as  it  aids,  but  must  not 
be  led  into  error.    A  false  uterine  seal  occurs  in  cervicitis, 


598  Diseases  of  the  Genital  Organs 

and,  while  I  have  not  seen  the  false  seal  in  pyometra,  it  may 
occur. 

The  cervix  is  frequently  sclerotic  and  its  canal  difficult  to 
pass.  Great  patience  is  often  required.  First  the  dilators 
should  be  carefully  introduced  and  the  cervix  slowly  and 
liberally  dilated.  The  complete  dilation  is  valuable  in  diag- 
nosis and  essential  in  handling. 

When  the  canal  has  been  well  dilated,  the  small  uterine 
catheter  (Fig.  39)  or  far  better  the  soft  rubber  horse  cath- 
eter or  the  seven-foot  bull-douching  catheter  is  to  be  intro- 
duced. In  most  cases  of  pyometra  the  metal  uterine  cathe- 
ter suffices  for  diagnosis,  but  in  rare  cases,  when  the  uter- 
us is  unusually  paretic,  the  pus  is  not  douched  out  with  the 
catheter  even  though  gallons  be  present.  When  fluid  is  in- 
troduced through  the  metal  catheter,  it  simply  disappears 
and  is  irrecoverable  with  that  instrument.  This  should  in- 
dicate to  the  practitioner  that  he  has  erred  in  diagnosis  and 
is  trying  to  douche  a  pregnant  uterus,  that  he  has  erred  in 
technic  and  penetrated  the  peritoneal  cavity,  or  that  there 
is  extensive  pyometra  dragging  the  uterus  far  forward  and 
downward,  and  the  douche  has  been  added  to  the  content. 
Unless  one  undertakes  the  imprudent  and  perilous  filling  of 
the  flaccid  uterus  until  it  literally  runs  over,  the  diagnosis 
must  be  made  with  the  rubber  catheter  used  as  a  siphon. 
The  cervix  must  be  well  dilated  for  this  purpose,  the  uter- 
ine dilators  engaged  in  the  fenestrum  of  the  catheter,  and, 
with  the  cervix  drawn  well  back  with  the  uterine  forceps, 
the  catheter  introduced  carefully  through  the  canal  into  the 
uterus.  The  catheter  is  held  in  place,  the  uterine  dilator 
withdrawn,  and  the  catheter  gently  pushed  onward  as  far 
as  may  be  prudent.  It  is  then  filled  with  fluid  (salt  solu- 
tion, Lugol's  solution)  from  an  irrigator  or  otherwise  by 
gravity,  and  some  of  the  fluid  may  be  allowed  to  pass  into 
the  uterus.  The  distal  end  of  the  catheter  is  to  be  com- 
pressed firmly  while  completely  filled  with  the  fluid.  It  is 
then  lowered  and  the  compression  removed,  when  purulent 
or  other  liquid  contents  siphon  out.  If  the  precaution  is  not 
taken  to  compress  the  catheter  while  elevated  and  filled  witli 


Pyometra  599 

fluid,  and  the  uterus  is  very  flabby,  the  fluid  will  drop  into 
the  inert  uterus  and  the  siphon  be  destroyed. 

The  pathologic  changes  in  pyometra  have  not  been  ex- 
tensively studied  histologically.  As  observed  macroscopi- 
cally,  the  uterine  v^alls  are  thickened  and  somewhat  sclero- 
tic. In  the  abattoir,  when  examined  on  the  killing  floor,  the 
mucosa  is  usually  of  a  dark  bluish  or  bluish-black  color, 
roughened  and  showing  evidences  of  partial  destruction. 
It  is  only  very  rarely  that  the  mucosa  has  undergone  total 
necrosis.  In  many  cases  the  mucosa  is  nodular  or  granular, 
as  indicated  in  Fig.  184.  The  elevations  are  pale  yellow  and 
suggestive  at  first  glance  of  tuberculosis.  The  most  sug- 
gestive element  seen  with  the  naked  eye  is  the  extensive 
changes  in  the  uterine  mucosa,  which  will  demand  for  re- 
covery a  comparatively  long  time.  Brief  and  fragmentary 
bacteriologic  studies  of  pyometra  indicate  that  the  pus  in- 
fection is  as  varied  as  that  of  wounds.  There  is  no  evidence 
to  indicate  that  the  bacteria  present  are  specifically  diff"erent 
from  those  prevailing  in  wound  infections. 

The  prognosis  of  pyometra  must  be  based  upon  the  inter- 
pretation of  the  pathologic  changes  which  are  present. 
The  two  immovable  barriers  to  reproductive  recovery  are 
total  destruction  of  the  endometrium  and  the  extension  of 
the  infection  into  the  oviducts.  Both  conditions  are  diffi- 
cult of  positive  recognition.  The  outlook  for  the  life  and 
the  general  health  of  the  patient  is  good,  and  if  it  may  be 
safely  assumed  that  the  uterine  mucosa  is  not  destroyed 
and  the  oviducts  not  irremediably  involved,  the  breeding 
life  of  the  animal  can  probably  be  preserved.  The  treatment 
consists  essentially  of  the  dilation  of  the  cervical  canal,  the 
removal  of  the  purulent  contents,  the  disinfection  of  the 
uterine  cavity,  and  the  removal  of  the  corpus  luteum,  if 
present.  The  dilation  of  the  cervical  canal,  as  advised 
for  diagnosis,  suffices.  The  removal  of  the  pus  is  best 
accomplished  by  means  of  the  seven-foot  bull-douching 
catheter  with  a  hospital  irrigator  fitted  with  a  stop- 
cock. The  catheter  is  introduced  into  the  uterus  as  for 
diagnosis    and    sufficient    physiologic    salt    solution    gravi- 


6oo  Diseases  of  the  Cienital  Organs 

tated  into  the  uterus  to  dilute  some  of  the  pus  and 
start  the  siphon.  The  distal  end  is  then  lowered  and 
as  much  of  the  pus  as  possible  siphoned  out.  More 
of  the  solution  is  then  introduced  and  the  siphon  again 
brought  into  play.  The  catheter  should  be  pushed  cautiously 
as  far  into  the  apex  of  the  horn  as  is  safe.  Heavy  pus  is  to 
be  cautiously  broken  up  by  massage  of  the  uterus  per  rec- 
tum. It  should  be  determined  that  both  horns  are  being 
emptied.  Sometimes  this  may  be  accomplished  by  massage 
with  the  catheter  in  one  horn  only.  Sometimes  it  is  essen- 
tial to  introduce  the  catheter  into  each  horn.  This  may  gen- 
erally be  accomplished  by  directing  the  catheter  to  the  right 
or  to  the  left  with  the  dilator  when  introducing  it.  The 
catheter  may  also  be  directed  into  the  horn  desired  by  man- 
ipulation per  rectum.  The  douching  should  be  continued 
until  the  fluid  siphons  out  clear.  The  uterus  may  then  be 
washed  well  with  V4  to  2  per  cent.  Lugol's  solution  and, 
after  this  has  been  carefully  siphoned  out,  there  may  be  in- 
troduced into  the  uterine  cavity  eight  to  sixteen  ounces  of 
liquid  paraffin  holding  in  suspension  one-half  ounce  each  of 
iodoform  and  bismuth. 

If  the  pyometra  is  a  direct  continuation  of  infection  from 
the  puerperal  period,  the  corpus  luteum  of  pregnancy  is  quite 
certainly  present  and  has  sunk  deeply  within  the  ovary.  In 
most  other  cases  of  pyometra,  a  central  retained  corpus  lu- 
teum is  present.  Professor  Hess  first  drew  definite  atten- 
tion to  the  inhibitory  action  exerted  upon  the  uterus  by  a  re- 
tained corpus  luteum.  While  repeated  douching  of  the  uterus 
may  finally  disinfect  it,  the  dislodgment  of  the  corpus  lu- 
teum with  destruction  of  its  inhibitory  power  constitutes  a 
great  and  essential  aid.  The  dislodgment  generally  causes 
estrum  with  uterine  engorgement  and  sharp  tonic  contrac- 
tions which  tend  to  expel  pus  and  diminish  the  infection. 
The  technic  of  pressing  out  the  corpus  luteum  has  already 
been  discussed  under  "Central  or  Embedded  Corpus  Lu- 
teum". The  douching  of  the  uterus  should  be  repeated  as 
frequently  as  prudent,  generally  once  in  two  weeks,  some- 
times more  often.    Coitus  should  be  excluded  as  long  as  the 


Uterine  Abscess  60 1 

pyometra  is  present  and  for  several  weeks  thereafter  until 
the  uterus  has  had  an  ample  rest  and  has  recovered  its  gen- 
eral tone.  Early  copulation  usually  causes  a  recurrence  of 
the  disease. 

C.  Uterine  Abscess 

Abscessation  of  the  post-puerperal  uterus  occurs  when 
there  is  a  virulent  purulent  infection  within  its  cavity  and 
the  cervical  canal  becomes  closed  by  inflammatory  adhe- 
sions or  from  other  causes.  A  diff'erent  type  of  uterine  ab- 
scess has  already  been  described  under  "The  Infections  of 
the  Gravid  Uterus",  in  which  the  putrefying  embryo  or  fetus 
is  the  fundamental  cause. 

Post-puerperal  uterine  abscess  usually  follows  badly 
handled  retention  of  the  fetal  membranes  or  other  type  of 
metritis.  It  is  most  commonly  one  of  the  results  of  handling 
retained  placenta  as  a  definite  disease  which  is  considered 
as  ended  when  the  fetal  membranes  are  supposed  to  have 
been  removed.  The  abscessation  ordinarily  becomes  estab- 
lished three  to  four  weeks  after  the  termination  of  preg- 
nancy. 

There  are  no  outstanding  clinical  symptoms  of  uterine  ab- 
scess. The  cow  has  usually  experienced  difficulty  in  calving 
or  aborting,  and  her  recovery  has  been  slow.  Her  general 
condition  is  quite  regularly  bad,  though  a  fair  appetite  may 
remai)!  and  some  milk  be  secreted.  The  chief  clinical  symp- 
toms are  not  based  directly  upon  the  abscess  itself,  but  upon 
the  involvement  of  other  organs.  If  the  abscess  presses 
upon,  or  points  into,  the  urinary  bladder,  difficult  urination 
logically  ensues.  Later,  if  the  abscess  ruptures  into  the 
bladder,  the  urine  contains  large  volumes  of  pus.  Most  fre- 
quently the  uterine  abscess  involves  the  rectum  and  causes 
adhesion  to  and  stricture  of  the  intestine,  with  difficult  defe- 
cation, ending  finally  with  rupture  of  the  abscess  into  the 
bowel.  The  pus  is  later  evacuated  with  the  feces.  After- 
ward the  rectal  adhesion  remains,  as  shown  at  5  in  Fig.  187, 
and  is  readily  recognizable  upon  palpation.  When  general 
pelvic  adhesions  have  not  occurred,  the  diagnosis  is  ordinari- 


6o2 


Diseases  of  the  Genital  Organs 


ly  simple  both  during  the  existence  of  the  abscess  and.  when 
rupturing  into  the  rectum,  after  healing  has  occurred.  When 
pelvic  adhesions  become  general,  the  rupture  of  an  abscess 
into  the  rectum  may  still  be  accurately  diagnosed,  but  owing 
to  the  indistinctness  of  the  adherent  mass,  physical  exami- 
nation can  not  determine  whether  the  abscess  was  uterine  or 
parametritic.  But  in  either  case  the  breeding  life  of  the 
patient  is  closed  so  that  accurate  diagnosis  is  not  imperative. 


I'lG.  187 — Abscessation  of  Uterus  with  Pelvic  Adhesions. 

LetlL-riiii^  iiicliules  that  for   187a. 

/,    Cervix;    2,    2,    2,  uterine    and  cornual    abscesses;   j,     walls  of  urinary 

bladder;    4,   adhesion  of   uterine  horn  to  bladder ;    5,  adherent  rectum 

■  into  which  uterine  abscess  has  ruptured  ;    6,  encapsuled  ovary  with 

cystic  corpus  luteum  ;    7,  thin  girdle  of  lutein  tissue. 

There  is  no  handling  to  advise  for  the  restoration  of  the 
breeding  powers.  There  remains  only  the  salvaging  of  the 
animal  for  beef  or  possibly  for  a  brief  dairying  period. 
Even  then  there  is  little  of  value  to  do  beyond  directing  good 
general  care  and,  where  possible,  advancing  recovery  by  the 
opening  of  the  abscess  instead  of  awaiting  its  spontaneous 
rupture.  I  have  opened  the  abscess  when  mature  by  thrust- 
ing a  finger  through  the  rectal  floor  into  the  abscess  cavity. 


Abscessation  of  Uterine  Subiiiucosa 


60  ■ 


Fig.   187a — For  lettering  see  Fig.  187. 


6o4  Diseases  of  the  Genital  Organs 

The  abscess  can  be  prevented  only  by  closely  following  cases 
of  metritis  during  the  puerperal  period  and  seeing  that  the 
infection  is  not  permitted  to  continue  into  the  post-puer- 
peral era. 

D.  Abscessation  of  Uterine  Submucosa 
I  have  in  my  collection  an  abattoir  specimen  of  tiny  ab- 
scesses in  the  uterine  submucosa,  as  shown  in  Fig.  188.  The 


Fig.  i88— Submucous  Uterine  Abscesses. 
/,  Vagina  ;    2,  cervix  ;  j,  cornual  cavity  ;   /,  abscesses. 

mucosa  is  thrown  into  numerous  marked  elevations  which 
when  incised  reveal  an  abscess  the  size  of  a  very  small  pea, 
containing  thick  yellowish-white  pus.  The  walls  of  the  ab- 
scess are  not  very  dense.  The  character  of  the  disease,  the 
method  of  clinical  diagnosis,  the  handling,  and  the  progno- 
sis are  questions  upon  which  no  definite  opinion  can  be  ex- 
pressed. 


Sclerotic  Metritis 


605 


E.  Sclerotic  Metritis. 
Sclerosis  of  the  uterine  walls  generally  accompanies  long- 
continued  metritis,  but  as  a  rule  the  sclerosis  is  not  very 
marked.  There  may  be  distinguished  upon  rectal  palpation 
a  definite  thickening  and  hardening  of  the  walls,  which  does 
not  constitute  an  important  factor  in  the  prognosis  and 
handling  of  the  disease.  If  the  uterine  mucosa  is  restored 
to  health,  the  sclerosis  abates  and  disappears.  There  is, 
however,  an  extreme  type  of  sclerosis  which  is  not  rare  and 


Fig.  189 — Sclerotic  Metritis  with  Pyometra. 

/,     Cervical  canal  ;    2,   sclerotic  annular  folds  of  cervix  pushing  canal  far 

downward  ;  j,  cavity  of  uterus  and  born  containing  pus. 

Uterine  mucosa  destroyed. 

which  it  is  important  to  recognize  clinically.  This  type  I 
have  designated  as  sclerotic  metritis.  It  is  characterized 
by  greatly  thickened  walls,  one-half  to  one  inch  in  diameter, 
very  dense  and  hard.  A  typical  example  is  shown  in  Fig. 
189.  The  disease  is  evidently  the  result  of  long-continued 
intra-uterine  irritation.  It  may  be  due  to  fetal  retention, 
as  shown  in  Fig.  171.  In  the  definitely  post-puerperal  cases 
I  have  not  been  able  to  trace  the  disease  to  its  fundamental 
cause  as  all  my  examples  are  from  the  abattoir  and  hence 
without  clinical  history.  It  appears  fairly  safe  to  attribute 
the  condition  ordinarily  to  neglected  or  maltreated  retained 


6o6  Diseases  of  the  Genital  Organs 

fetal  membranes,  though  any  intense  irritation  should  be 
competent  to  cause  it. 

Clinically  the  symptoms  are  a  constant,  usually  fetid  uter- 
ine discharge  of  limited  volume.  The  sclerotic  state  of  the 
walls  prevents  sacculation  of  the  uterus,  with  large  accumu- 
lations of  pus,  and  renders  the  discharge  essentially  con- 
stant. Clinical  examination  reveals  pus  in  the  vagina  and, 
by  douching,  in  the  uterus.  Rectal  palpation  discloses  an 
enlarged,  very  hard,  cartilage-like  uterus,  usually  regular  in 
contour.  The  hardness  is  similar  to  that  of  some  cases  of 
puerperal  metritis,  but  the  history  of  the  recent  termina- 
tion of  pregnancy  serves  to  differentiate.  In  the  latter  case 
the  hardness  disappears  with  the  control  of  the  metritis. 
In  all  specimens  in  my  collection  the  uterine  mucosa  is  to- 
tally destroyed  and  the  breeding  life  of  the  animal  definitely 
closed.  The  condition  does  not  visibly  affect  the  general 
health  of  the  animal  nor  decrease  the  value  of  its  carcass  for 
human  food.  There  is  probably  very  little,  if  anything,  to 
be  gained  by  treatment. 

F.  Pelvic  Adhesions.  Parametritis 
Parametritis  with  pelvic  adhesions  and  abscesses  is  a 
common  result  of  intense  intra-uterine  infection.  The  extra- 
uterine infections  vary  widely  in  origin.  Unquestionably 
some  cases  arise  from  the  infection  passing  through  the  ovi- 
duct and  escaping  into  the  peritoneal  cavity.  These,  how- 
ever, usually  expend  their  energy  in  producing  cystic  de- 
generation of  the  corpus  luteum  and  adhesions  of  the  ovary 
in  the  pavilion  of  the  oviduct  and  in  the  ovarian  pocket. 
This  is  elsewhere  considered.  Extensive  pelvic  adhesions 
are  the  common  result  of  non-mortal  rupture  of  the  uterus 
with  the  escape  of  infectious  material,  or  of  the  injection  of 
irritant  antiseptics  into  the  peritoneal  cavity.  Infection  also 
invades  the  genital  peritoneum  from  the  endometrium 
through  the  muscle  layers  of  the  uterus  and.  having  gained 
the  serous  covering,  involves  by  contiguity  the  adjacent  per- 
itoneal surfaces,  and  the  contiguous  surfaces  adhere. 

The  most  potent  cause  of  pelvic  adhesions  and  abscesses 


Pelvic  Adhesions.      Parametritis 


607 


is  the  improper  effort  at  removing  an  irremovable  retained 
afterbirth.  In  one  herd  where  six  cows  had  suffered  from 
retention  of  the  fetal  membranes  and  attempts  had  been 
made  by  the  attending  veterinarian  to  remove  them  manu- 
ally, I  sent  three  (50  per  cent.)  directly  to  the  butcher  on  ac- 
count of  pelvic  adhesions  and  abscesses. 

The  clinical  symptoms  of  pelvic  adhesions  and  abscesses 
are  vague  and  inconclusive.  There  is  ordinarily  a  history  of 
disease  at  the  time  of  parturition,  from  which  recovery  has 


Fig.  igo— Adhesion  of  "Uterus  to  Bladder. 

r,  Vagina  ;  B,  urinary  bladder  ;    U.  uterus  ;  /,  adhesive  band  passing  from 

uterine  horn  to  bladder. 

been  tardy  and  imperfect.  The  animal  is  rarely  in  good  con- 
dition and  is  generally  emaciated,  with  a  lustreless  coat. 
When  the  adhesions  are  quite  extensive  the  movements  of 
the  animal  are  careful,  hesitant  and  stiff.  The  back  is  fre- 
quently arched. 

Clinical  examination  by  palpation  through  the  rectum  dis- 
closes adhesions  of  the  uterus,  oviducts  and  ovaries  to  the 
pelvic  walls,  rectum,  bladder,  rumen,  or  other  adjacent 
structures.  It  is  essential  to  accurate  diagnosis  that  trac- 
tion be  applied  to  the  cervix  with  the  uterine  forceps.  This 
affords  the  examiner  a  definite  base  (the  cervix)  from  which 
to  extend  palpation,  and  the  tension  brings  out,  if  such  re- 
sult is  possible,  the  contour  of  the  diseased  uterus.  Depend- 
ing upon  the  degree  of  adhesion,  the  nature  of  the  lesions 


6o8  Diseases  of  the  Gejiital  Organs 

may  be  more  or  less  clearly  determined.  When  very  exten- 
sive, the  identity  of  uterine  horns,  oviducts  and  ovaries  be- 
comes lost  in  the  adherent  masses.  Here  and  there  may  be 
gross  sclerotic  masses  which  may  with  security  be  diagnosed 
as  sclerotic  abscesses,  but  it  can  not  be  told  whether  the  ab- 
scesses are  within  the  uterus  or  one  of  the  uterine  horns,  the 
oviduct,  the  ovary,  or  some  intra-pelvic  lymph  gland  or 
other  structure. 


Fic.  191— Pelvic  Adhesions. 

Cervix  ;  2,  cornu  ;   j  (insert)  cross  section  of  cornu  with  pus  ; 

/,  cross  section  of  ovary. 


Pelvic  Adhesions       Paraniciritis 


609 


Fig.   192 — Extensive  Pelvic  Adhesions. 

/,     Uterine   body  ;     2,    cornua  ;     j,    right   ovary,    completely    encapsuled  ; 

7,  right  oviduct,  cystic  and  adherent  ;  5,  corpus  luteuni  in  left  ovary  ; 

<5,  cyst  in  corpus  luteum 

The  disease  is  not  amenable  to  treatment.  The  animal 
should  be  slaughtered  and  the  carcass  used  for  food  or  other 
disposition  made  of  it  according  to  conditions. 

F.  Pyemia.     Arthritis.     Abscesses  of  the  Ductless  Glands. 

When  the  intra-uterine  infection  by  its  virulence  breaks 
down  or  renders  non-resistant  the  protective  epithelium  of 
the  uterus,  or  an  imprudent  effort  is  made  to  remove  the 
fetal  membranes  and  epithelial  wounds  or  abrasions  occur, 
an  inviting  opening  is  made  for  the  entrance  of  the  intra- 
uterine infection  into  the  blood  or  lymph  capillaries,  whence 

39 


6io  Diseases  of  flic  Genital  Organs 

it  gains  the  general  circulation  and  may  be  carried  any- 
where. In  the  puerperal  period  observations  upon  such  in- 
vasions of  the  body  fluids  by  bacteria  from  the  diseased 
uterus  are  limited  to  the  profound  sepsis  induced,  which 
generally  destroys  the  life  of  the  patient.  If  the  invader  is 
less  virulent,  its  effects  are  not  immediately  recognized  be- 
cause the  uterine  disease  is  so  pronounced  that  it  over- 
shadows all  else.  Later  when  a  small  volume  of  infection 
or  infection  of  only  moderate  virulence  enters  the  blood 
stream,  it  may  finally  become  lodged  in  some  remote  organ 
or  tissue,  establishing  lesions  and  inducing  symptoms  not 
directly  referable  to  the  infected  genital  tract.  The  conclu- 
sion that  such  lesions  are  referable  to  intra-uterine  infec- 
tion is  based  upon  the  fact  that  they  are  common  in  associa- 
tion with  genital  infections  but  are  otherwise  rare  in  cows. 
Pyemia  of  genital  origin  may  occur  at  almost  any  period, 
probably  most  often  during  the  puerperium,  but,  as  already 
noted,  it  may  then  pass  unobserved.  It  is  most  frequently 
observed  during  the  interval  following  the  puerperal  period 
after  the  close  of  one  pregnancy  up  to  the  date  of  the  next 
conception.  Generally  the  clinical  symptoms  become  obvi- 
ous at  from  three  to  six  weeks  after  the  close  of  pregnancy. 
I  have  observed  it  in  pregnancy  while  the  metritis  of  preg- 
nancy was  laying  the  foundation  for  abortion  which  oc- 
curred a  few  weeks  later. 

In  cattle  "pyemic  arthntis  is  the  most  striking  and  fre- 
quent type  of  pyemia  due  to  genital  infection.  It  may  in- 
volve any  joint  in  the  body,  but  is  most  frequently  seen  in 
the  stifle  or  femoro-tibial  articulation  (pyemic  goniti^,) .  The 
lameness  is  usually  intense,  but  may  be  of  any  degree. 
There  is  usually  distinct  swelling,  most  readily  detected  as 
a  rule  at  the  median  side  of  the  femoro-tibial  articulation, 
or  revealed  by  the  distension  of  the  femoro-patellar  syno- 
vial bursa.  Heat  and  pain  upon  pressure  are  usually  recog- 
nizable by  palpation.  The  uterus  shows  the  presence  of  in- 
fection or  there  is  a  definite  history  of  the  existence  of  geni- 
tal disease  in  the  recent  past.  When  involving  other  articu- 
lations the  symptoms  are  essentially  analogous  to  those  when 
the  stifle  is  aflected. 


Pyemia.     Arthritis.     Abscesses  of  the  Ductless  Glands      6ii 

The  outlook  for  recovery  from  pyemic  arthritis  is  very 
poor.  Potassium  iodide  internally  has  given  apparently 
good  results  in  some  of  my  cases,  but  it  must  be  used  with 
great  caution  because  of  the  high  susceptibility  of  cattle  to 
iodine.  If  pus  forms  and  samples  can  be  aspirated  for  cul- 
tures, autogenous  vaccines  are  worthy  of  trial.  Locally 
little  can  be  accomplished.  The  inflamed  articulation  may 
be  fomented  or  blisters  may  be  applied.  Should  the  presence 
of  pus  be  positively  diagnosed,  it  may  be  aspirated  and  the 
cavity  refilled  with  20  per  cent.  Lugol's  solution  in  water  or 
glycerine.  If  an  abscess  forms,  it  should  be  opened  freely 
and  the  cavity  packed  with  gauze  saturated  with  tincture 
of  iodine  mixed  with  glycerine,  or  with  some  other  suitable 
disinfectant.  Movement  of  the  joint  should  be  restrained  in 
any  manner  available. 

The  uterine  cavity,  if  still  an  active  center  of  infection, 
should  receive  proper  attention.  The  general  care  ox  the 
animal  should  be  of  the  best. 

Abscesses  of  the  liver  and  other  glands  are  occasionally  ob- 
served during  or  subsequent  to  severe  uterine  infection. 
The  clinical  symptoms  of  such  abcesses  are  vague  and  gen- 
erally fail  to  afford  secure  ground  for  diagnosis.  The  domi- 
nant symptom  generally  is  that  of  ill  health  with  gradual 
emaciation.  Should  the  abscess  rupture  externally,  as  some- 
times occurs  when  located  in  the  liver  or  kidney,  diagnosis 
may  be  possible.  The  alert  practitioner  should  always  sus- 
pect pyemic  disturbances  when  ill  health  follows  the  termi- 
nation of  pregnancy,  and  should  make  the  most  careful 
search  possible  for  pyemic  abscesses.  In  such  cases  labora- 
tory examination  of  the  blood  is  highly  important  and  should 
not  be  neglected. 

H.  Cystic  Degeneration  of  the  Uterine  Walls 

with  Hydrometra. 

Hydrometra,  or  distension  of  the  uterus  with  liquid,  is  not 

common  and  is  dependent  upon  a  variety  of  causes.     It  has 

already  been  noted  that  mucus  and  menstrual  debris  may  be 

retained  in  and  distend  the  uterus  when  the  cervical  canal 


6r2  Diseases  of  the  Genital  Organs 

has  failed  to  open,  owing  to  an  arrest  in  the  development  of 
the  embryo.  It  has  likewise  been  stated  that,  when  the  hy- 
men remains  imperforate,  the  accumulation  of  mucus  and 
menstrual  debris  eventually  forces  the  cervical  canal  and 
distends  the  uterus.     Various  changes  in  the  cervix  may 


Fig.    193     Cystic   Degeneration  of  Uterine    Walls    with    Excessive 

Hyidrometra.     Uterus  contained  about  10  gallons  of  lymph 
/.Cervix;    _-',   cavity  of  left  hdni,   rij;hl   in    shadow;     ,•   (iiiscit)  section  of 
CNStic  ovary.      (Insert,  l)t>lo\v)  luilarjjjcd  section  of  wall  ^pholoiirapli.  1 

cause  a  retention  of  the  uterine  discharges.  It  will  also  be 
shown,  while  dealing  with  the  diseases  of  the  vagina,  that 
atresia  resulting  from  vaginitis  dams  back  uterine  and 
cervical    secretions    and    distends    the    uterus    with    fluid. 


Cystic  Degeneration  of  the  Uterijie  Walls  ivith  Hydrometra    613 

It  is  desired  here  to  describe  a  disease  of  the  uterus 
itself  resulting  in  the  formation  of  a  large  amount  of  fluid 
which  is  passively  retained  within  the  uterine  cavity.  I 
have  seen  clinically  several  cases  in  which  the  cervical  canal 
was  free  and  readily  admitted  the  catheter,  while  the  uterus 
contained  a  large  volume  of  clear,  odorless,  watery  fluid. 
I  have  been  able  to  secure  the  uterus  of  one  of  these  cases, 
illustrated  in  Fig.  193.  This  valuable  cow  had  long  been 
sterile.  Upon  examination  I  found  the  uterus  greatly  en- 
larged, flabby,  and  dropped  far  forward  so  that  only  the 
cervical  end  could  be  palpated.  No  cotyledons  were  palp- 
able and  the  uterine  arteries  signified  non-pregnancy.  The 
cervical  canal,  which  was  open,  though  the  insertion  of  the 
metal  uterine  catheter  caused  but  little  fluid  to  escape,  was 
gently  dilated.  I  introduced  a  rubber  horse  catheter  and, 
using  it  as  a  siphon,  obtained  a  large  amount  of  clear, 
watery  fluid  estimated  at  ten  gallons.  A  few  weeks  later 
I  siphoned  out  about  five  gallons  more.  A  colleague  re- 
moved the  fluid  several  times,  but  there  was  no  improve- 
ment and  the  cow  was  slaughtered.  The  uterus  was  greatly 
distended  at  time  of  slaughter,  showing  that  the  fluid  was 
quickly  renewed.  The  uterine  mucosa,  as  shown  in  Fig. 
193,  is  filled  everywhere  with  small  transparent  cysts.  The 
normal  mucosa  has  disappeared  completely.  The  fluid  con- 
tents of  the  uterus  apparently  emanated  from  the  cystic 
degeneration  of  the  mucosa.  So  far  as  known,  the  disease 
is  beyond  remedy,  at  least  in  so  far  as  reproduction  is 
concerned. 

This  condition  may  be  responsible  for  a  few  of  the  ex- 
treme cases  of  pyometra  I  have  cited.  They  might  very 
well  have  been  identical  at  first  with  the  case  just  described, 
and  colleagues,  having  unsuccessfully  attempted  to  douche 
the  uterus,  may  have  carried  infection  into  the  vast  re- 
servoir of  fluid  and  converted  the  hydometra  into  pyometra. 
The  only  important  element  in  connection  with  hydrometra, 
according  to  my  observation,  is  an  accurate  diagnosis. 
Slaughter  should  follow. 


6i4  Diseases  of  the  Genital  Orgatis 

6.    Cervical  Infections 

A.  Cervicitis 

A  careful  study  of  the  anatomy  of  the  bovine  cervix,  as 
described  on  page  33  and  illustrated  by  Figs.  15  and  16, 
shows  it  to  be  an  extremely  complex  organ,  admirably 
adapted,  at  first  glance,  to  act  as  an  important  barrier  be- 
tween the  copulatory  segment  of  the  genital  tube — the 
vagina — and  the  nutritive  area  in  which  the  embryo  is 
destined  to  develop — the  uterus.  If,  however,  infection 
gains  a  foothold  within  its  intricate  mucous  folds,  what 
appears  at  first  as  a  highly  efiicient  barrier  becomes  a  very 
serious  hiding-place  for  bacteria.  The  cervix  is  one  of  the 
most  important  areas  of  the  entire  genital  system  in  re- 
lation to  serious  infections.  The  cervix  of  the  cow  rarely 
fails  after  two  or  more  pregnancies  to  show  at  its  vaginal 
end  clinically  visible  lesions.  The  changes  are  so  nearly 
universal  that  the  milder  types  of  disease  constitute  the 
"normal"  cervix  of  anatomists.  The  vaginal  end  of  the 
cervix  of  the  ordinary  virgin  heifer  should,  I  believe,  be 
taken  as  the  standard  for  that  part  of  the  organ  and  any 
material  departure  from  that  type  regarded  as  pathologic. 

Prior  to  pregnancy  the  cervix  of  the  heifer  has  received 
little  clinical  study.  It  is  difficult  to  bring  it  into  convenient 
position  for  visual  inspection  without  using  an  undesirable 
amount  of  force.  Until  the  heifer  has  failed  to  conceive 
after  repeated  coitus,  she  is  assumed  to  be  free  from  genital 
disease.  After  such  failure  to  conceive,  if  a  veterinarian 
makes  an  examination,  he  frequently  finds  the  cervix  dis- 
eased. As  a  rule,  however,  the  disease  has  not  notably 
modified  the  vaginal  end  of  the  cervix,  so  far  as  can  be  seen, 
the  exterior  appearing  sound,  but  disease  of  the  deeper  parts 
of  the  cervix  is  recognized  by  instrumental  examination  of 
the  cervical  canal.  After  the  termination  of  pregnancy  by 
parturition  or  abortion,  changes  occur  in  the  vaginal  end  of 
the  cervix,  readily  seen  upon  clinical  examination,  which 
profoundly  alter  its  appearance  and  character.  Tli(>  most 
striking  changes  are  delineated  in  Fig.   19  1.  in  \vhi\li  it   is 


Cervicitis 


615 


shown  that  with  breeding  the  cervical  mucosa  becomes  tume- 
fied, and  hypertrophied,  and  finally  portions  of  it  evaginate 
through  the  os  uteri  externum.  The  prolapsed  portions 
are  described  by  anatomists  as  the  lips  of  the  cervix.  As  a 
matter  of  fact  they  are  the  hypertrophied  rugae  of  the  first 
annular  fold  of  the  cervical  mucosa  and  are  not  visible  in 
the  healthy  virgin  heifer.  The  actual  os  uteri  externum, 
covered  with  vaginal  mucosa,  is  forced  aside  by  the  hyper- 
trophied first  annular  ring.    The  true  lips  of  the  os  uteri 


##<»# 


Fig.  194— Vaginal  Ends  of  Cervices. 

Numerals   indicate   lips   of    original   os   uteri    externum  ;     letters    signify 

protrusion   of   the   first   annular   folds   in    varying   degrees. 

In  /,  2,  and  S,  the  fold  does  not  protrude. 

externum  finally  form  a  pale-colored  girdle  about  the  base 
of  the  prolapsed  portion  of  the  cervical  mucosa.  Here, 
often  one  to  several  inches  from  the  vaginal  extremity  of 
the  cervical  canal,  the  pavement  epithelium  of  the  vagina 
ends  and  the  cervical  epithelium  with  its  intricate  and  ela- 
borate mucous  glands  succeeds.  The  secretions  of  the  two 
areas  are  wholly  unlike.  The  protruding  cervical  mucosa, 
like  that  remaining  within  the  cervical  canal,  takes  the 
leading  part  in  the  elaboration  of  the  thin  mucus  of  estrum 
and,  in  pregnancy,  of  the  uterine  seal. 


6i6  Diseases  of  the  Genital  Organs 

Cervicitis  is  the  result  of  bacterial  invasion  of  the  cervical 
mucosa.  The  origin  of  the  infection  and  its  date  of  invasion 
have  not  been  fully  determined.  Clinicians  know  well  that 
heifers  conceive  with  greater  difficulty  than  cows.  That  is, 
the  average  number  of  copulations  essential  to  pregnancy 
is  greater  by  50  to  100  per  cent,  than  is  required  for  cows. 
There  is  present  some  form  of  temporary  interference  with 
conception,  which  is  ultimately  eluded  and  pregnancy  en- 
sues. As  a  rule,  also,  abortion  and  retained  fetal  mem- 
branes occur  in  heifers  in  first  pregnancy  50  to  100  per 
cent,  more  frequently  than  in  cows.  These  two  conditions 
we  know  are  referable  to  an  infection  radiating  from  the 
cervical  end  of  the  uterus,  and  it  appears  quite  justifiable 
to  conclude  that  in  those  cases  where  recognizable  fertiliza- 
tion has  failed  these  conditions  are  parallel.  Either  the 
cervicitis  present  inhibits  fertilization  for  a  time,  or  fertili- 
zation occurs  and  the  cervical  infection  works  destruction 
so  promptly  that  estrum  recurs  in  its  regular  cycle  or  at  a 
later  date. 

When  clinical  examination  of  a  sterile  heifer  is  made, 
ovarian  or  tubal  disease  is  recognized  in  only  a  minority  of 
cases.  When  exploration  of  the  cervical  canal  is  undertaken, 
it  is  found  abnormally  tortuous  and  difficult  of  passage  be- 
cause the  bases  of  the  mucous  folds  have  become  sclerotic 
and  hypertrophied.  Probably  there  is  a  bit  of  muco-pus  in 
the  cervical  canal.  The  diagnosis  of  cervicitis  is  unescap- 
able,  but  its  source  and  the  date  of  invasion  are  not  wholly 
clear.  I  cannot  logically  separate  the  source  and  date  of 
invasion  in  these  cases  from  those  of  abortion  and  retained 
fetal  membranes.  The  undeniable  clinical  fact,  that,  in  a 
herd  well  saturated  with  genital  infections,  the  heifers  abort 
50  to  100  per  cent,  more  frequently  than  cows,  though  all 
are  kept  under  identical  conditions  in  the  same  stable  or  field 
and  are  bred  to  the  same  bull,  testifies  that  the  heifers  ar- 
rive at  breeding  age  with  the  infection  resident  in  the 
cervix.  That  is.  if  in  a  given  herd  the  observed  rate  of  the 
expulsion  of  fetal  cadavers  in  cows  is  10  per  cent,  and  in 
heifers  20  per  cent.,  though  kept  and  bred  alike,  at  Joast  50 


Cervicitis  617 

per  cent,  of  the  heifer  abortions  should  be  attributed  to 
causes  existing  at  conception.  Analogous  conclusions  must 
follow  regarding  cervicitis  causing  sterility.  There  are 
then  three  outstanding  causes  of  cervicitis : 

1.  In  cervicitis  existing  when  the  heifer  reaches  puberty, 
present  observations  indicate  that  infection  existing  at  this 
date  is  referable  to  invasion  of  the  fetus  or  of  the  calf  dur- 
ing the  nursing  period,  which  will  be  discussed  under 
''Congenital  Infections  of  Calves." 

2.  Coital  transmission  of  infection  by  the  bull.  This 
has  been  discussed  while  considering  genital  infections  of 
bulls.  In  one  large  herd  where  intense  cervicitis  involved 
over  60  per  cent,  of  the  cows,  treatment  was  of  little  avail 
until  finally  the  bulls  were  examined,  slaughtered,  and 
healthy  bulls  substituted.  The  bull  is  frequently  the  chief 
and  by  far  the  most  important  infection-bearer. 

3.  Imprudent  handling  of  cows  for  sterility.  I  have 
observed  some  very  intense  outbreaks  where  the  spread  of 
the  infection  appeared  to  be  due  to  the  veterinarian  who 
was  handling  the  cows  for  sterility.  Those  veterinarians 
who  have  led  themselves  to  believe  that  in  the  post-puer- 
peral period  it  is  safer  and  more  effective  to  douche  the 
uterus  with  0.6  or  0.7  per  cent,  soda  or  salt  solution,  if 
they  do  not  sterilize  their  uterine  catheters  or  other  in- 
struments before  using  upon  each  cow,  constitute  a  serious 
peril  to  the  animals  they  handle,  and,  so  far  as  I  have  been 
able  to  understand  some  outbreaks  I  have  seen,  frequently 
do  incalcuable  harm. 

Once  the  infection  has  become  implanted,  the  chief  ele- 
ments in  intensification  are  coitus  and  parturition  (or  abor- 
tion.) I  have  douched  the  uteri  of  several  cows  two,  three 
or  more  days  after  coitus,  and  have  always  obtained  muco- 
pus  in  the  returned  fluid.  Whether  this  is  the  invariable 
rule,  I  do  not  kow.  The  same  cows  do  not  have  such  muco- 
pus  without  coitus.    It  is  not  the  effect  of  estrum. 

The  influence  of  parturition  or  abortion  upon  cervicitis 
is  very  marked.  The  contractions  of  the  uterine  walls  force 
the  fetus  against  the  cervix  and  push  its  walls  apart.     The 


6i8  Diseases  of  the  Genital  Organs 

force  causes  a  rent  in  a  diseased  part  already  infected  in 
many  cases.  More  frequently  the  force  abrades  the  mucous 
membrane,  affording  innumerable  openings  to  bacterial  in- 
vasion. The  peril  is  frequently  accentuated  by  the  presence 
of  metritis,  often  with  retained  fetal  membranes  which 
undergo  decomposition  so  that  the  cervix  is  submerged  by 
infective  discharges  and  putrefying  membranes.  Under 
these  conditions  each  parturition  leaves  its  mark  upon  the 
cervix. 

The  simplest  clinical  evidence  of  cervicitis  is  a  swelling  of 
the  first  annular  cervical  ring,  which  pushes  the  margins  of 
the  lips  of  the  os  uteri  externum  apart,  so  that  the  ring  be- 
comes visible  lying  within  the  cervical  canal,  deeply  injected 
and  bright  scarlet  or  dark  red  in  color.  Next  appears  the 
prolapse  or  ectropia  of  the  first  mucous  ring  through  the  os 
uteri  externum.  As  the  annular  ring  prolapses  farther  and 
the  infection  increases,  the  longitudinal  foldings  of  the  cer- 
vical mucosa  become  increasingly  evident,  and  the  hyper- 
trophied  mucosa  of  the  annular  cervical  fold  evolves  into  an 
encircling  series  of  club-shaped  tumors.  The  second  an- 
nular ring  may  participate.  Finally  the  hypertrophy  may 
become  very  gross  and  the  tumefied  cervical  mucosa  pro- 
trude out  into  the  vagina  like  a  cauliflower,  four,  six  or 
more  inches  in  diameter,  scarlet  or  dark  red  in  color,  and 
highly  vascular,  bleeding  at  touch.  The  extremes  are  illus- 
trated in  Fig.  194  and  in  Colored  Plate  VI.  Between  these 
extremes  every  possible  variation  appears. 

The  cervical  secretions  in  cervicitis  are  as  variable  as 
the  tumefaction  and  hypertrophy.  If  two  or  more  pairs  of 
uterine  forceps  are  fixed  upon  the  cervix,  traction  applied, 
and  the  forceps  handles  spread  apart,  the  vaginal  portion 
of  the  cervix,  as  a  rule,  is  brought  freely  into  view,  and  the 
inflamed  cervical  mucosa  is  open  to  visual  examination.  In 
the  milder  types  illustrated  in  Fig.  194,  no  secretion  of 
notable  character  is  observed.  If  the  visual  examination  is 
supplemented  by  inserting  the  dilator  into  the  cervical  canal, 
and  the  jaws  are  opened,  there  may  ooze  out  between  them 
a  drop  or  two  of  muco-pus.     If  lhi>  uterine  catheter  is  in- 


£2 


£  ^ 


O  £ 


Cervicitis 


619 


troduced  and  exploratory  douching  attempted,  the  first  fluid 
to  return  is  probably  a  mil  or  two  of  muco-pus  which  has 
been  caught  in  the  fenestrum  of  the  outer  catheter  tube  as 
it  passed  through  the  cervical  canal. 

As  the  intensity  of  the  disease  advances,  there  appear 
two  divergent  types  of  secretion — mucous  and  purulent. 
That  of  the  mucous  type,  in  its  extreme  form,  is  represented 
in  Colored  Plate  VI.  The  cervical  glands  in  the  mucosa  of 
the  great  angry  red  tumor  secrete  a  viscid,  tough  mucus  re- 
sembling in  varying  degrees  the  uterine  seal.     It  may  be 


Fig.  196 — Uterine  Syringe  with  Conical  and  Curved  Nozzles. 

softer  or  more  resistant  than  the  seal.  I  have  met  clin- 
ically cases  where  the  secretion  was  so  voluminous  and  its 
resistance  so  great  that  it  defied  my  efforts  at  passing 
dilator,  catheter,  or  other  instrument  through  the  cervical 
canal  into  the  uterus. 

In  the  purulent  type,  in  sharp  contrast  to  the  preceding, 
abundant  pus  is  formed,  chiefly  in  the  vaginal  end.  The  pus 
accumulates  in  varying  quantities  in  the  cervical  end  of  the 
vagina,  from  which  it  is  intermittently  expelled.  The  pus, 
ordinarily  offering  nothing  remarkable  in  character,  is  gen- 
erally thin  and  is  yellowish  or  grayish  white.  Sometimes  it 
is  very  fetid ;  sometimes  non-fetid. 


620  Diseases  of  the  Genital  Organs 

The  intensity  of  the  disease  at  the  vaginal  end  of  the  cer- 
vix does  not  furnish  a  reliable  criterion  regarding  the  state 
of  the  cervix  in  its  more  anterior  portions.  Any  or  all  of 
the  annular  mucous  folds  may  be  involved,  resulting  in  the 
elongation  of  the  free,  projecting  portion,  with  sclerosis  of 
the  base  of  the  fold.  The  swollen  free  margin  projecting  to- 
ward the  vagina  fills  the  canal  and  interferes  with  the  pas- 
sage of  the  catheter  or  other  instrument,  partly  by  the  direct 
filling  of  the  canal,  but  chiefly  by  the  elongated  mucous  folds 
projecting  vaginalward,  behind  w^hich  the  catheter  becomes 
engaged.  The  sclerosis  of  the  base  of  the  annular  folds  is 
one  of  the  commonest  and  most  striking  lesions  in  cervicitis. 
When  marked,  as  illustrated  in  Fig.  189,  the  sclerotic  base 
pushes  the  canal  out  of  its  course  and  forces  the  opposite 
wall  of  the  cervix  to  yield.  The  sclerosis  thus  causes  the 
cervical  canal  to  bend  with  varying  degrees  of  abruptness, 
dorsal  ward  or  ventralward,  to  the  right  or  to  the  left,  ac- 
cording to  the  location  and  extent  of  the  sclerosis.  Some- 
times the  fourth  or  last  annular  fold  at  the  uterine  end  be- 
comes sclerotic,  and,  pushing  in  the  direction  of  least  re- 
sistance, forms  a  cone  projecting  into  the  uterine  cavity, 
which,  acting  as  a  collapsing  valve  and  imprisoning  men- 
strual debris,  causes  uterine  distension.  Little  is  known  of 
the  histo-pathologic  changes  in  the  cervix.  The  scanty 
studies  show  that  generally  there  is  desquamation  of  the 
external  epithelial  strata  with  desquamation  of  the  epithe- 
lial lining  of  the  mucus,  or,  as  they  might  be  termed  in  preg- 
nancy, the  seal-secreting  glands.  The  desquamation  of  the 
general  cervical  epithelium  tends  constantly  toward  adhe- 
sions between  the  contiguous  denuded  surfaces,  but  the  reg- 
ular physiologic  discharge  of  uterine  secretions,  especially 
at  the  estrual  period,  counteracts,  at  least  as  a  rule,  complete 
cervical  atresia.  I  have  not  observed,  clinically  or  in  the 
abattoir,  a  complete  obliteration  of  the  cervical  canal  as  a 
direct  result  of  cervicitis.  I  have  observed  clinically  three 
or  four  cases,  always  in  heifers  in  first  pregnancy,  of  adhe- 
sions between  contiguous  denuded  surfaces  of  the  first  an- 
nular ring,  which  so  narrowed  the  cervical  canal  as  to  rcii- 


Cervicitis  621 

der  parturition  impossible  without  surgical  interference,  but 
in  no  case  hermetically  sealed  the  canal.  I  have  seen  com- 
plete atresia  of  the  cervical  canal  only  in  uterine  abscess  un- 
less the  arrest  in  development  of  the  cervix  in  the  embryo, 
in  which  the  canal  fails  to  become  excavated,  may  be  called 
atresia. 

The  bacteriology  of  cervicitis,  in  any  reliable  measure,  is 
yet  to  be  learned.  Thus  far  the  chief  invader  recognized  is 
the  streptococcus  viridans.  There  is  doubtless  a  wide  varia- 
tion in  bacteria.  In  purulent  cervicitis  the  streptococcus 
viridans  is  probably  not  the  real  offender.  In  histologic 
section  of  the  inflamed  mucosa,  bacteria  are  abundant, 
especially  within  the  mucous  glands,  where  they  mingle  with 
the  epithelial  debris. 

The  prognosis  of  cervicitis  is  dependent  upon  its  in- 
tensity, type  and  duration.  In  itself,  cervicitis  is  gen- 
erally remediable,  but,  if  intense  and  neglected,  the  in- 
fection tends  to  invade  the  oviducts  and  pass  beyond  surgi- 
cal control.  Many  cases  recover  spontaneously  or  are  of  so 
mild  a  type  that  the  disease  does  not  prevent  conception.  As 
a  rule,  cervicitis  of  moderate  or  great  intensity  either  de- 
lays or  prevents  conception.  The  exact  method  by  which  it 
interferes  with  conception  has  not  been  fully  determined. 
In  certain  extreme  cases  the  profuse  secretion  of  tenacious 
mucus  apparently  entangles  the  spermatozoa  and  inhibits 
their  migration  to  the  oviduct.  In  some  cases  the  bacterial 
toxins  present  probably  disable  and  eventually  destroy  the 
spermatozoa,  but  in  a  very  large  measure  the  copious  secre- 
tion of  mucus  during  estrum  floods  the  cervical  canal  and 
vagina,  washes  away  or  submerges  the  bacteria,  and  serves 
as  a  protective  bridge  over  the  infected  mucosa,  in  which 
the  spermatozoa  may  move  freely  and  safely. 

The  greatest  danger  from  cervicitis  apparently  arises 
after  fertilization.  Then  the  infection  tends  to  inhibit  the 
prompt  physiologic  sealing  of  the  canal  and  is  free  to  attack 
the  embryo  immediately  it  arrives  in  the  uterine  cavity. 
Cervicitis  is  the  fundamental  lesion  in  abortion  and  re- 
tained fetal  membranes.     In  all  recorded  cases  of  autopsy 


622  Diseases  of  the  Genital  Oroafis 

following  abortion,  in  which  the  location  of  the  endometritis 
is  stated,  the  abortion-causing  metritis  has  radiated  from 
the  cervical  end  of  the  uterus.  This  has  been  illustrated  in 
Fig.  174  and  in  colored  Plates  III  and  IV.  Clinically  there 
is  found  an  unsealed  cervical  canal  with  pronounced  cervi- 
citis and  the  embryonic  sac  necrotic  at  its  cervical  end. 

Cervicitis  is  not  an  absolute  barrier  to  pregnancy  even 
when  severe.  It  is  not  rare  to  find  severe  cervicitis,  with 
engorged,  angry-red  and  swollen  mucosa,  when  the  animal 
is  pregnant  and  to  all  appearances  safe.  In  three  instances 
I  have  observed  purulent  cervicitis  at  the  vaginal  end  with 
copious  suppuration  and  with  a  pint  or  two  of  fetid  pus  in 
the  vagina,  though  the  cow  was  pregnant  and  calved  suc- 
cessfully. But  in  such  cases  the  suppuration  was  confined 
to  the  vaginal  end  of  the  cervix  while  the  uterine  end  was 
successfully  resisting  the  threatened  invasion  and  the  an- 
terior end  of  the  canal  was  securely  sealed. 

Cervicitis  is  seen  in  cows  of  all  ages.  Severe  cervicitis 
with  great  cervical  hypertrophy  often  abates;  the  cervix 
retains  its  hypertrophy,  but  the  inflammation  ceases  and  the 
cow  breeds  safely. 

The  handling  of  cervicitis  is  essentially  a  problem  in  dis- 
infection. As  in  wound  infection,  so  in  cervical  infection, 
the  best  results  demand  prompt  and  skillful  handling.  The 
inevitable  cervicitis  of  retained  fetal  membranes  and  other 
forms  of  metritis  accompanied  by  suppuration  should  be 
given  careful  attention  during  the  puerperal  period,  and 
the  disease  not  permitted  to  persist  into  the  post-puerperal 
era.  At  this  time  the  chief  weapon  against  the  cervicitis  is 
the  removal  of  the  source  of  the  irritation  by  properly 
handling  the  metritis.  The  same  is  true  of  many  cases  of 
cervicitis  existing  at  other  periods:  if  uterine  disease  is 
present,  its  control  must  precede  the  direct  handling  of  the 
malady. 

In  the  milder  types  of  disease,  if  2  per  cent,  of  Luafol's  so- 
lution is  used  to  douche  the  uterus,  the  remnant  of  the  fluid 
left  in  the  cavity  trickles  out  through  the  cervical  canal,  and 
in  many  cases  suttices  to  disinfect  it.     It  is  inadvisable  to 


Cervicitis 


623 


trust  to  this.  I  find  it  best  as  a  rule  in  the  mild  and  moder- 
ately severe  cases  to  swab  the  cervical  canal  throughout  its 
length  with  full  strength  Lugol's  solution.  For  this  purpose 
I  use  the  uterine  dressing  forceps.  (Fig.  39,  3.)  With  these 
I  secure  as  large  a  piece  of  absorbent  cotton  or  gauze  as  can 
readily  be  pushed  through  the  canal,  saturate  it  with  the  so- 
lution, and  pass  it  through  the  length  of  the  canal,  revolving 
the  swab  to  and  fro  in  an  effort  to  touch  every  part  of  the 
mucosa.  Where  the  cervical  mucosa  is  badly  denuded,  the 
application  causes  necrosis  of  the  superficial  layers  of  epi- 
thelium and  arouses  a  marked  reaction  in  the  tissues.  When 


Fig.   197 — Cervical  Abscess. 
/,  Cervix  ;  2,  abscesses  ;  j,  hydrosalpinx. 

the  thin  pellicle  of  dead  cells  is  thrown  off,  a  rapidly-healing 
surface  remains.  A  second  application  may  be  made  in 
three  weeks  if  it  appears  desirable.  If  the  case  is  not  too 
severe,  the  swabbing  commonly  gives  satisfactory  results. 
In  some  instances  the  cervicitis  will  respond  better  to  the 
application  of  a  10  to  20  per  cent,  silver  nitrate  solution. 

When  discussing  the  instrumental  examination  of  the 
cervical  canal  on  page  99,  warning  was  given  that  the  ex- 
aminer should  proceed  with  great  caution  in  passing  instru- 
ments through  it.  This  becomes  of  special  importance  where 
the  cervical  canal  is  seriously  infected.  The  cervicitis,  often 
rendering  the  passing  of  a  sound  or  catheter  exceedingly 
difficult,  invites  accident  and  the  infection  present,  which  is 


624  Diseases  of  the  (lenilal  Organs 

naturally  pushed  into  any  wound,  greatly  intensifies  the 
danger.  In  the  worst  cases  of  injury  a  vast  phlegmon  de- 
velops in  the  pelvic  areolar  tissue,  imperiling  the  life  and 
destroying  the  value  of  the  animal.  In  lesser  injuries,  like 
those  depicted  in  Figs.  197,  198  abscesses  occur.  These  in- 
fected centers  develop  about  them  highly  resistant,  sclerotic 
abscess  walls  which  remove  or  diminish  the  peril  to  life  but 
are  generally  beyond  practical  repair  so  far  as  breeding  is 
concerned. 


Fig.  198 — Cervical  Abscess  from  "Opening  the  Womb."  Ventral  Side. 

/,  Cervix;    2,    abscess  with  sclerotic  wall.s  ;    ,\  cross  section  of  healthy 

uterine  corinia  in  shadow.     'I'lie  main  volume  of  cervix,  uterus, 

and  coruua  lie  behiml  (above)  the  abscess. 

When  severe  purulent  cervicitis  exists  in  pregnant  cows, 
it  should  be  handled  chiefly  by  vaginal  douches,  consisting 
of  i/|.  per  cent,  of  Lugol's  solution,  chlorazene,  or  other 
equivalent.  No  radical  attempt  should  be  made  to  eliminate 
the  suppuration,  but  an  effort  made  gently  to  ameliorate  it 
until  the  clothe  of  pregnancy,  when  the  disease  may  be  at- 
tacked with  anii)lo  vigor. 


Tracheoplasty  625 

When  a  fissure  occurs  in  the  cervix  at  time  of  parturition, 
the  injury  commonly  passes  unseen  until  faulty  healing  has 
occurred  with  a  troublesome  cicatrix.  Sometimes  the  seri- 
ousness of  the  cervicitis  is  caused  by  the  imprudent  use  of 
the  scalpel  to  overcome  dystocia  falsely  diagnosed  as  being 
due  to  atresia  or  stricture  when  in  fact  the  cervix  is  normal 
and  fails  to  dilate  because  the  uterus  is  atonic  owing  to  the 
presence  of  infection.  In  such  instances  there  is  often  a 
false  impression  of  recovery,  the  cervix  healing  with  a  bad 
cicatrix  which  invites  serious  cervical  infection. 

Numerous  cases  of  severe  cervicitis  without  a  history  of 
fissure  or  incision,  which  will  not  yield  to  the  application  of 
disinfectants,  demand  for  satisfactory  handling  surgical  in- 
terference. 

Tracheoplasty 

Tracheoplasty  is  indicated  in  refractory  cervicitis  and 
when  there  are  structural  changes  which  cause  sterility, 
either  directly  or  by  reason  of  such  lesions  as  cause  the  cer- 
vix to  be  more  prone  to  disease.  Tracheoplasty  in  itself 
plays  little  part  in  cervical  surgery  of  the  cow,  but  certain 
plastic  procedures,  intrinsically  involved  in  all  cervical  sur- 
gery, play  a  very  important  role  in  the  attaining  of  satis- 
factory results.  Tracheoplasty  is  intended  to  restore  the 
cervix  as  nearly  as  possible  to  its  normal  morphology  and 
tissue  condition.  Since  most  of  the  cases  of  cervicitis 
result  directly  from  injury  or  from  the  succeeding  inflam- 
mation, the  subject  is  largely  covered  under  succeeding 
heads.  Where  there  is  an  inflammatory  process  of  the  mu- 
cosa and  muscular  walls,  it  has  been  my  experience  that  a 
simple  tracheoplastic  operation  does  not  give  satisfactory 
results  and  in  its  stead  a  partial  trachelectomy  should  be 
performed. 

A  marked  hypertrophy  or  elongation  of  one  cervical  lip 
may  call  for  amputation  of  this  portion.  In  this  case  a  cir- 
cular incision  is  made  through  the  mucosa  around  the  base 
of  the  elongated  lip,  and  at  either  side  of  the  base  an  in- 
cision is  directed  at  such  an  angle  into  the  fibromuscular 
tissue  that  they  converge  to  excise  a  wedge-shaped  piece  of 
40 


626  Diseases  of  the  Genital  Organs 

the  latter  tissue.  With  No.  2  or  3  chromatized  catgut,  the 
endocervical  and  vaginal  mucosa  are  brought  together  with 
interrupted  sutures. 

Trachelorrhaphy 

The  treatment  of  lacerations  of  the  cervix,  although  in 
general  it  has  received  little  consideration,  is  a  subject 
having  no  little  importance.  At  the  time  of  parturition, 
most  cows  receive  at  least  minor  lacerations  or  epithelial 
abrasions,  and  a  certain  percentage  of  these,  dependent  upon 
the  degree  of  infection  present,  ultimately  develop  an  endo- 
cervical inflammation  (See  Fig.  199). 

Repair  of  epithelial  lacerations  should  be  secured  within 
a  short  time  after  parturition,  before  inflammatory  pro- 
cesses have  arisen  or  healing  occurred  by  cicatrix.  Such 
repairs  are  almost  wholly  limited  to  the  region  of  the  first 
cervical  fold  and  the  parts  posterior  to  it. 

In  order  to  remedy  such  injuries  the  cervix  is  retracted 
into  the  vaginal  introitus,  using  strong  vulsellum  or  tenacu- 
lum forceps,  placed  in  such  a  manner  as  to  prevent  any  en- 
docervical injury.  The  cervix  may  further  be  brought  into 
view  by  the  use  of  one  or  more  cervico-vaginal  speculums, 
which  serve  to  push  aside  the  vulvar  lips.  The  cervical  lips 
are  now  spread  apart,  exposing  the  laceration ;  if  the  lips 
are  much  constricted,  forming  a  very  small  os,  the  first  fold 
may  be  retracted  gently  with  a  pair  of  small  tenaculum  for- 
ceps and  everted  slightly  to  expose  the  laceration  sufficiently 
for  repair.  Using  a  No.  4  half-circle  Mayo  catgut  needle. 
or  similar  pattern,  with  No.  0  or  No.  1  catgut,  the  lacera- 
tion is  closed  with  either  an  interrupted  or  a  continuous 
suture,  but  the  former  will  secure  a  better  coaptation  in 
most  cases.  The  needle  is  usually  best  passed  through  both 
margins  of  the  wound  at  once,  from  the  side  which  is  most 
accessible,  turned  upon  its  long  axis,  and  the  point  brought 
sufficiently  into  view  that  it  may  be  grasped  by  the  needle 
holders.  Great  care  must  be  taken  not  to  tear  the  mucosa, 
since  the  replacement  of  the  sutures  becomes  extremely 
difficult.  For  this  reason,  the  Mayo  cervix  needle  is  prefer- 
able to  others,  as  it  punches  rather  than  cuts  a  hole.     All 


Track  elorrh  aphy 


627 


sutures  should  be  forceps-tied  because  the  suturing  is  usu- 
ally so  much  within  the  vaginal  introitus  or  cervical  canal 
that  digital  tying  exerts  too  great  a  strain  upon  the  mucosal 
margins. 

Tears  or  lacerations  of  the  cervical  lips  heal  more  rapidly 
than  do  those  of  the  endocervix  at  or  anterior  to  the  first 
fold.  The  endocervical  mucosa  on  one  side  and  the  vaginal 
mucosa  on  the  other  soon  become  fused,  v^ith  the  formation, 
however,  of  considerable  eschar  tissue.   This  causes  a  gap- 


FiG.  199 — Laceration  of  Lips  of  Cervix  Uteri. 

Vaginal  mucosa  ;    2,  vaginal  aspect  of  cervical  lip  ;  j,  endocervical  aspect 
of  lip  ;    4,  intensely  inflamed  first  annular  fold.  '  On  the  right  side  are 
shown  the  margins  of  an  old  laceration,  the  posterior  angles  of 
which  are  held  apart  by  the  lower  forceps. 


628  Diseases  of  the  Genital  Organs 

ing  of  the  lips  with  a  partial  eversion  of  the  first  fold,  or. 
if  this  fold  becomes  inflamed,  a  severe  ectropia  results.  It 
is  of  considerable  importance  that  the  normal  tissue  rela- 
tions be  maintained  or  restored,  since  upon  this  is  depend- 
ent to  a  great  extent  the  future  health  and  physiological  fit- 
ness of  the  utero-cervical  canal. 

The  cervix  is  retracted,  as  in  the  former  case,  well  into 
the  vaginal  introitus  and  tenaculum  forceps  placed  on  either 
side  of  the  laceration.  The  margins  of  the  wound  are  de- 
nuded, taking  care  that  fresh  surfaces  are  left  in  each  layer 
of  mucosa  and  in  the  fibro-muscular  layer  between.  All 
cicatricial  tissue  is  removed.  The  surfaces  denuded  must 
be  left  smooth  and  even  in  order  to  attain  a  satisfactory 
coaptation.  When  making  the  denudation,  trachelorrhaphy 
scissors  are  found  very  helpful. 

The  denuded  area  on  each  side  presents  an  inner  layer  of 
endocervical  mucosa,  an  outer  layer  of  vaginal  mucosa  and, 
between  these,  the  dense  fibro-muscular  tissue.  A  correct 
coaptation  of  mucosa  to  mucosa  must  be  obtained.  Begin- 
ning at  the  anterior  commissure  of  the  wound,  interrupted 
sutures  are  placed  at  intervals  of  about  one-quarter  inch. 
These  are  inserted  by  directing  the  needle  inward  through 
the  vaginal  mucosa  near  its  margin  on  one  side,  and,  after 
penetrating  deeply  into  the  fibro-muscular  tissue,  bringing 
it  out  at  the  margin  of  the  endocervical  mucosa  without 
penetrating  it.  This  order  is  reversed  on  the  other  side  of 
the  laceration.  The  suture  is  tied  firmly  and  cut  off,  leaving 
an  inch  or  two  of  its  end  so  that  it  may  be  readily  picked  up 
at  a  later  date  for  removal.  The  sutures  are  thus  continued, 
at  about  one-quarter  inch  intervals  to  within  about  one-half 
to  three-quarters  of  an  inch  from  the  posterior  margin  of 
the  lips,  where  one  suture  is  placed  at  right  angles  to  the 
preceding :  that  is,  piercing  the  mucosa  of  the  posterior  edge 
of  the  lip  about  one-eighth  inch  from  the  edge  of  the  wound, 
the  needle  is  directed,  anteriorly,  deeply  into  the  fibro-mus- 
cular tissue,  and  emerges  midway  between  the  endocervical 
and  vaginal  mucosa  about  one-half  to  three-quarters  inch 
anterior  to  the  os.     It  is  passed  then  in  the  reverse  order 


Trachclon-Juxphy  629 

through  the  opposite  margin  of  the  laceration.  This  suture, 
tied  firmly  on  the  posterior  margin  of  the  os,  prevents  gap- 
ing of  the  lips. 

Care  should  be  taken  that  none  of  the  sutures  penetrate 
the  endocervical  mucosa  because,  should  this  occur,  they  will 
not  become  buried  and  a  complete  healing  of  the  endocervi- 
cal mucosa  by  first  intention  can  not  occur.  If  the  sutures 
are  properly  placed  they  may  be  removed  after  ten  to  fifteen 
days  without  injury  to  the  endocervix.  It  is  important  to 
bear  in  mind  also,  in  the  attainment  of  correct  coaptation  of 
surfaces,  that  the  margins  of  the  laceration  must  be  smooth 
and  straight  and  that  a  puckering  of  the  opposing  margins 
must  be  prevented. 

The  fibro-muscular  tissue  of  the  cervix  is  very  tough,  and 
sometimes  difficult  to  penetrate.  When  suturing  this  tissue, 
a  very  strong  needle  with  a  sharp  cutting  point  is  required. 
Ferguson's  abdominal  needles,  Dibrell's  needles,  and  Dr. 
Howard  Crutcher's  perineum  needle  have  been  found  to  be 
well  adapted  for  this. 

When  it  is  desired  to  use  the  perineal  needle,  it  should  be 
threaded  with  one  end  of  the  suture  quite  short  and  passed 
from  the  inside,  between  the  endocervical  mucosa  and  fibro- 
muscular  tissue,  outward  through  the  latter  and  the  vaginal 
mucosa.  The  short  end  of  the  suture  is  now  caught  and  the 
needle,  still  threaded,  is  withdrawn  and  passed  in  the  same 
manner  through  the  opposite  margin  of  the  laceration, 
whence  it  is  withdrawn  unthreaded. 

Lacerations  through  the  fibrous  structure  of  the  cervix 
cause  a  gaping,  of  the  wound,  to  control  which  the  sutures, 
as  above  described,  are  subject  to  considerable  tension.  A 
non-elastic  suture  such  as  braided  silk  is  usually  the  most 
suitable.  The  size  of  the  suture  material  should  be  such 
that  the  desired  parts  can  be  firmly  and  permanently 
brought  into  apposition.  For  the  posterior  margin  of  the 
lips  heavier  suture  material  than  for  the  other  portions, 
usually  No.  4  to  No.  8  braided  silk,  is  used.  Catgut  used 
in  this  region  is  generally  very  unsatisfactory,  as  its  elas- 
ticity permits  the  apposed  margins  to  separate  sufficiently 


630  Diseases  of  the  Genital  Orga^is 

that  coaptation  ceases.  When  the  tear  of  the  lip  is  verj' 
long,  it  will  not  be  found  advisable  to  tie  the  first  sutures 
until  several  of  them  have  been  placed  and  it  is  ascertained 
that  the  margins  will  not  pucker.  When  a  simple  dilation 
of  the  lips  occurs,  without  trace  of  longitudinal  laceration, 
the  lumen  is  narrowed  by  the  excision  of  a  wedge-shaped 
segment  from  a  convenient  location  in  the  circumference  of 
the  lip.  The  piece  excised  must  be  of  such  size  and  shape 
that,  when  the  denuded  surfaces  are  brought  together,  the 
tissue  relation  is  maintained  and  the  organ  is  restored  to  as 
nearly  its  normal  appearance  as  possible.  The  segment  is 
best  removed  with  right  and  left  trachelorrhaphy  scissors, 
after  which  the  wound  is  closed  as  previously  described. 

Trachelectomy 

The  term  trachelectomy  is  used  here  to  denote  various  de- 
grees of  cervical  amputation.  Different  conditions  of  the 
cervix  call  for  a  somewhat  varied  type  of  trachelectomy  and 
tracheloplasty.  Before  attempting  trachelectomy,  the  oper- 
ator should  make  himself  thoroughly  familiar  with  the  nor- 
mal structure  of  the  cervix.  The  operation  should  accom- 
plish the  removal  of  all  diseased  cervical  tissue  and  attain 
as  complete  a  tracheloplasty  as  possible.  Care  should  al- 
ways be  taken  to  protect  the  healthy  cervical  tissue,  espe- 
cially the  endocervical  mucosa,  from  injury  during  the 
operation.  The  operator  should  bear  in  mind  that  the  cervi- 
cal canal  is  normally  very  small  and  that,  when  there  is  any 
considerable  dilation  in  the  presence  of  an  inflammatory 
process,  that  portion  of  the  endocervical  mucosa  which  lines 
the  dilated  section  must  usually  be  considered  as  diseased. 
Although  it  may  not  be  apparent,  in  many  cases  there  have 
been  destructive  changes  which  render  it  physiologically 
functionless. 

Excision  of  the  Prolapsed  Endocervical  Fold 

The  excision  of  the  first  fold,  when  seriously  inflamed,  is 
frequently  indicated.  It  should  be  performed  only  wIumi  Die 
inflammatory  process  is  confined  to  the  first    fold  and   its 


Excision  of  the  Prolapsed  Endocervical  Fold  631 

base  is  readily  accessible.  The  cervix  is  retracted  into  the 
vaginal  introitus  and  the  inflamed  fold  is  grasped  with  a 
pair  of  tenaculum  forceps,  or,  if  the  margin  of  this  fold  is 
very  ragged,  a  heavy  pair  of  hemostats  may  be  used,  thus 
straightening  out  the  unevenness  of  the  part  and  allowing  a 
straighter  line  of  incision  to  be  made  through  the  mucosa 
parallel  to  the  forceps.  The  incision  is  best  commenced  on 
the  outer  side  of  the  fold  and  carried  through  the  healthy 
mucosa  at  the  margin  of  the  inflammatory  area,  making  an 
encircling  incision  through  the  mucous  membrane  at  the 
base  of  the  piece  to  be  removed.  Then,  incising  a  little  at  a 
time,  first  on  the  outer,  then  on  the  inner  side  of  the  fold, 
the  point  of  the  scalpel  being  directed  towards  its  base,  a 
wedge-shaped  piece  of  fibro-muscular  cervical  tissue  is  re- 
moved. This  leaves  two  free  edges  of  mucous  membrane 
which  are  sutured  together  with  No.  0  or  No.  1  chromatized 
catgut,  using  an  interrupted  or  running  suture  as  conditions 
may  demand.  Healing  should  occur  by  first  intention.  The 
needle  best  adapted  for  this  suturing  is  a  %,  or  full-curved 
cervix  needle  \y^  to  1%  inches  long.  Great  care  should  be 
used  not  to  tear  out  the  sutures,  because  their  replacement 
is  very  difl^cult  and  proper  apposition  of  the  margins  is  not 
so  readily  attained.  Often  it  is  very  helpful  to  place  one 
suture  before  the  fold  is  completely  removed,  or,  when  re- 
moving the  fold,  to  catch  up  the  free  margins  of  the  mucosa 
with  fine  spring-catch  cilia  fixation  forceps,  thus  keeping 
the  fine  margins  of  mucosa  readily  available  for  suturing. 

Circular  Amputation  of  the  Cervix 

When  disease  of  the  cervix  is  of  such  character  that  one 
of  the  previous  methods  can  not  satisfactorily  remove  the 
inflamed  tissue,  it  becomes  necessary  to  establish  by  other 
means  a  continuity  of  the  healthy  endocervical  mucosa. 
This  may  best  be  accomplished  by  a  partial  circular  ampu- 
tation of  the  cervix,  including  in  the  excision  a  varied  por- 
tion of  the  cervical  fibro-muscular  tissue  along  with  the  dis- 
eased mucosa.  This  operation  is  extremely  well  adapted  to 
the  correction  of  the  large  ectropic  cervix    (the  so-called 


6^.2 


Diseases  of  the  Genital  Origans 


cauliflower  cervix)  and  of  endocervicitis  too  extensive  to  bo 
handled  by  the  mere  excision  of  a  prolapsed  fold. 

The  cervix  is  retracted  into  the  vaginal  introitus  and 
seized  with  a  strong  pair  of  vulsellum  forceps  with  one  jaw 
passed  deeply  into  the  cervical  canal,  or,  more  satisfactorily, 
with  a  specially  constructed  forceps  (Fig.  200  a,  2),  one  jaw 
having  double  tenaculae  and  the  other  tongue-shaped  so  that 
it  may  be  passed  deeply  into  the  canal  without  injury.  The 
cervix  is  freely  exposed  by  the  use  of  retractors  and  extra 
vulsellum  and  tenaculum  forceps  which  hold  aside  the  vulvar 


Fig.  200— Circular  Amputation  of  Cervix  Uteri. 

The    vaginal    mucosa    has    ht'c-ii    disscott'd    liuin    and    drawn    forwanl 
cervical  core.     _?,   Iu-tr<)])io  first  annular  fold  ;    ■,-,  ix])()sed  lihro- 
niusi-ular  tissue  of  cervit-al  core. 


Circula}  Aiupulation  of  the  Cervix 


633 


lips.  The  tissues  are  injected  at  frequent  intervals  with  a 
local  anaesthetic  to  which  adrenalin  chloride  has  been  added. 
A  circular  incision  is  now  made  around  the  margin  of  the 
true  cervical  lips,  as  shown  in  Fig.  200.  The  vaginal  mu- 
cosa is  seized  at  frequent  intervals  around  its  free  margin 
with  artery  forceps  and,  applying  moderate  traction,  is  care- 
fully dissected  from  the  underlying  cervical  body  as  far 
forward  as  the  endocervical  mucosa  is  diseased.    A  longitu- 


FiG.  200a— Special  Instruments  for  Trachelectomy. 

/,  Cervical  retractor  ;    i",  Tenaculum  forceps. 

dinal  incision  is  now  made  through  the  core  on  either  side, 
dividing  it,  for  the  entire  length  of  that  portion  which  has 
been  freed  from  the  vaginal  mucosa,  into  about  equal  upper 
and  lower  halves  (See  Fig.  201) .  At  this  point  in  the  opera- 
tion, it  should  be  ascertained  that  the  cervical  stump  is 
firmly  grasped  by  the  tenaculum  forceps,  because  at  a  later 
stage  their  replacement  would  become  very  difficult,  should 
their  hold  be  lost.  Each  of  the  two  segments  of  the  cervical 
core  has  an  inner  lining  membrane  of  endocervical  mucosa, 


634 


Diseases  of  the  Genital  Orga7is 


I'lc,  20I— Circular  Amputation  of  Cervix  Uteri. 

Cervical  core  divided  l)y  lon<,Mtudiii:il  incisions  (6)  into  superior  and  inferior 

segments,  {4).     The  internal  os,   7,    is  shown,  hounded   posleriorlv  ])v 

the  now  ex])osed  second  annular  fold  (amputation  ends  at  this" 

jjoint)  leaving  a  free  margin  of  endocervical  mucosa, 

as  shown  in  iMg.  202,  S. 


Circular  Amputation  of  the  Cervix  635 

outside  of  which  is  the  fibro-muscular  tissue  without  its 
covering  of  vaginal  mucosa.  Grasping  the  superior  segment 
and  pulling  sharply  upward  in  order  to  expose  the  endocer- 
vix  to  the  greatest  possible  extent,  a  semi-elliptical  incision 
is  made  through  the  endocervical  mucosa,  connecting  the 
anterior  ends  of  the  longitudinal  incisions.  The  convexity 
of  the  incision  is  directed  posteriorly.  The  scalpel  is  now  di- 
rected, parallel  to  the  incised  margin  of  the  mucosa,  towards 
the  uterus  for  a  short  distance  in  order  to  free  the  margin 
for  the  placing  of  sutures.  The  directions  of  the  amputating 
incisions  thus  form  a  more  or  less  V-shaped  decHvity  in  the 
posterior  extremity  of  the  stump,  the  mucosal  margins  of 
which  may  be  brought  together  readily  with  sutures.  The 
free  edge  of  the  endocervical  mucosa  is  now  secured  by 
toothed  fixation,  or  by  fine  artery  forceps.  Using  chroma- 
tized  catgut  sutures  No.  1  to  3,  and  a  %  or  full-curved  needle 
with  a  piercing  point,  the  free  margin  of  the  vaginal  mucosa 
above  is  brought  into  apposition  with  the  endocervical  mu- 
cosa below.  Usually  four  or  five  sutures  are  necessary  in 
apposing  these  margins.    (See  Fig.  202.) 

When  any  considerable  portion  of  the  cervix  has  been  re- 
moved, it  leaves  the  vaginal  mucosa,  which  has  been  sepa- 
rated from  it,  free  from  its  underlying  support.  In  order 
that  part  of  this  vacant  space  may  be  eliminated,  and  in  or- 
der to  prevent  too  great  a  strain  upon  the  endocervical  mar- 
gin, a  small  portion  of  the  fibro-muscular  cervical  tissue 
should  be  included  in  each  suture  (Fig.  203,  204). 

The  lower  segment  of  the  cervical  core  is  now  excised  and 
sutured  in  the  same  manner.  The  endocervix  has  thus  been 
brought  into  coaptation  with  the  vaginal  mucosa  both  above 
and  below.  At  the  lateral  commissures  of  the  os,  the  vaginal 
mucosa  sags  away  from  the  endocervical  mucosa.  Lateral 
to  this,  on  each  side,  an  excess  of  vaginal  mucosa  results 
from  the  marked  diminution  in  the  size  of  the  external  os — 
often  a  reduction  in  diameter  from  as  much  as  5  or  6  inches 
to  about  1/2  inch.  Coaptation  of  the  vaginal  mucosa  to  the 
lateral  margins  of  the  endocervical  mucosa  is  now  secured 
by  passing  on  each  side  a  suture  through  the  vaginal  mu- 


636 


Diseases  of  the  Genital  Organs 


iMC.  2m2  — Circular  Amputation  of  Cervix  Uteri. 

Showiii;^    cervix    al'lcr    superior    halt'     of    oerv  ii-al     cure    li.ls  been  excise 

9,  Margin  of  vajj;inal  mucosa  ;    ./,  inferior  lialf  of  divideil  core  ;  N,  seiui- 

elli])lical    marj^iii  of    eiul  jcervical    mucosa  ;  7,  ulero  cervical  canal. 

Jklweeu  .S'  and  ()  the  slriu-lure  consists  of  the  loose  ]iaracer\  ical 

tissue  and  the  tou"li  cervical  lil)ro muscular  tissue. 


Ci)cular  Aviputation  of  the  Cervix 


637 


cosa  from  above  about  Vj!  to  Vi-  inch  lateralwards  from  the 
previous  suture,  through  the  lateral  margin  of  the  endocer- 
vix  and  out  through  the  vaginal  mucosa  below  at  about  Va 
to  Vi  inch  laterward  from  the  lateral  inferior  suture.  Nov^ 
secure  the  lateral  commissure  of  the  vaginal  wound  with 
tenaculum  forceps  and,  by  gentle  traction,  making  the  ten- 


F u;.  203 — Circular  Amputation  of  Cervix  Uteri. 
Showing  cervix  after  excision  of  both  superior  and  inferior  halves  of 
cervical  body.  Vaginal  nuicosal  margins  brought  into  apposition  al)ove 
and  below  with  the  endocervix.  Angular  sutures  at  either  side  bring  into 
apposition  the  vaginal  mucosa  and  the  lateral  margins  of  the  eudocervical 
mucosa.  On  the  left  side  the  puckered  vaginal  mucosa  is  shown  free  from 
its  underlying  support  ;  on  the  right  it  has  been  removed,  leaving  an  oval 
opening  (9)  in  the  mucous  mendjrane.  Vaginal  sutures  are  shown  on  the 
right  side,  each  of  which  includes  a  small  portion  of  paracervical  tissue 
along  with  vaginal  nuicosa.     7,  utero  cervical  canal. 


Diseases  of  the  Genital  Organs 


Fig.  204— Circular  Amputation  of  Cervix  Uteri. 
Operation  Completed. 


Circular  Amputation  of  the  Cervix  639 

sion  about  equal  on  the  upper  and  lower  margins,  the  extent 
of  superfluous  vaginal  mucosa  is  ascertained.  An  approxi- 
mately oval-shaped  portion  of  the  extra  vaginal  mucosa  is 
removed  with  scissors  from  each  side  and  the  margins  ap- 
posed with  interrupted  silk  sutures,  each  of  which  should  in- 
For  purely  vaginal  sutures  silk  or  linen  is  best,  but  if  the 
suture  penetrates  the  endocervix  catgut  should  generally  be 
used.  If  proper  coaptation  of  the  parts  is  secured,  healing 
should  occur  by  first  intention, 
elude  a  small  portion  of  the  underlying  paracervical  tissue. 

After  the  disinfection  of  the  operative  area  with  iodine, 
the  single  pair  of  forceps  which  now  retract  the  cervix  are 
released,  allowing  the  organ  to  resume  its  normal  position. 
It  is  left  undisturbed  for  a  period  of  about  two  weeks,  when 
the  vaginal  sutures  are  removed  and  the  surfaces  touched 
over  with  pure  Lugol's  solution  of  iodine.  At  this  time,  pro- 
viding that  the  technic  has  been  thorough  and  efficient,  the 
appearance  of  the  mucosa  of  the  cervix  should  be  normal, 
with  but  slight  trace  of  the  operative  procedure. 

During  the  operation  it  will  be  found  advantageous  to 
maintain  a  constant  supply  of  1/2  to  1  per  cent,  chlorazene 
solution  for  the  irrigation  of  the  operative  area.  Capillary 
hemorrhage  should  be  almost  completely  controlled  by  the 
use  of  adrenalin  chloride. 

Circular  amputation,  although  requiring  considerably 
more  skill  and  effort  on  the  part  of  the  operator  than  other 
methods  of  procedure  used  in  the  correction  of  refractory 
cervicitis,  gives  the  most  satisfactory  results  of  any  technic 
which  the  author  has  used.  The  patient  is  usually  fit  for 
service  within  two  to  four  weeks  after  operation,  and  it  has 
been  my  experience  that,  in  the  absence  of  coexisting  com- 
plications in  other  portions  of  the  genital  apparatus,  con- 
ception usually  follows  very  promptly.  In  the  presence  of 
other  lesions  of  a  severe  nature  in  the  genital  tract,  such  as 
would  in  themselves  cause  sterility  of  a  more  or  less  per- 
manent character,  a  cervical  operation  is  not  usually  ad- 
visable. 


640  Diseases  of  the  Genital  Organs 

B.  Retention  of  Menstrual  Debris  from  Cervicitis' 
Uterine  distension  from  cervical  disease,  due  to  the  uter- 
ine end  of  the  cervical  mucosa  projecting  conically  into  the 
uterine  cavity  and  acting  as  a  collapsing  valve,  imprisoning 
the  uterine  secretions,  to  which  reference  has  been  made 
above,  is  extremely  rare.  I  have  observed  but  two  cases, 
both  clinical.  The  uterus  was  firmly  distended  with  fluid  as 
in  pregnancy,  but  the  two  horns  were  symmetrical,  A  cor- 
pus luteum  was  usually  present  but  shifted  from  one  ovary 
to  the  other  (alternation  of  ovulation  at  estrum).  The  uter- 
ine arteries  were  not  enlarged.  The  cervix  was  not  sealed. 
The  introduction  of  the  uterine  catheter,  which  required 
some  patience,  caused  the  evacuation  of  a  thin,  clear,  odor- 
less mucus. 

I  have  not  succeeded  in  restoring  such  animals  to  fertility. 
Generally  it  is  best  to  slaughter.  In  one  instance  I  cathe- 
terized  the  uterus  several  times  and  evacuated  the  fluid.  In 
another  case,  in  swabbing  the  cervix,  I  pushed  the  swab  into 
the  uterine  cavity,  beyond  the  conical  projection  of  the 
mucosa.  When  I  attempted  to  withdraw  the  swab,  the 
valve-like  projection  closed  upon  it  and  pulled  the  swab 
from  the  forceps.  The  recovery  and  withdrawal  of  the  swab 
gave  considerable  difficulty,  I  doubt  the  efficacy  of  handling. 
With  a  very  valuable  animal  probably  the  most  hopeful  plan 
would  be  a  complete  trachelectomy,  as  described  in  the  pre- 
ceding paragraph, 

1  There  is  a  legendary  atresia  of  the  cervical  canal  in  cattle,  which 
has  been  maintained  generation  after  generation.  It  has  its  basis  in 
the  common  ignorance  of  the  anatomy  of  the  bovine  cervix.  A  cow 
is  sterile,  a  man  attempts  to  pass  his  fingei-  through  the  cervical 
canal  and  naturally  fails,  and  a  diagnosis  of  cervical  atresia  or 
"closure  of  the  woriib"  is  made.  The  principle  is  the  same  as  when, 
a  generation  ago,  if  a  cow  was  ill,  a  hole  was  bored  in  her  horn,  a 
cavity  was  found  and  "hollow  horn"  diagnosed.  Atresia  of  the 
cervix  still  appears  in  some  textbooks  as  a  disease.  Rarely  does 
cervicitis  occlude  the  cervical  canal.  More  frequently  embryologic 
arrest  in  development  occurs  and  the  cervical  canal  is  not  formed. 
In  either  case  the  menstrual  debris  is  imprisoned  and  the  uterus  be- 
comes distended.  When  the  veterinarian  attempts  to  pass  the  dilator, 
catheter  or  other  instrument  through  the  cervical  canal  and  fails,  if 
atresia  exi.sts,  di.stension  of  the  uterus  inevitably  co-exists.  If  the 
distension  of  the  uterus  is  not  present,  a  diagnosis  of  cervical  atresia 
is  unjustifiable  and  false.  Atresia  of  the  cervical  canal  without  uter- 
ine distension  can  not  exist. 


Fetal  Retentioyi  from  Cervicitis.      Cervical  Adhesions      641 

C.   Fetal  Retention  from  Cervicitis.     Cervical  Adhesions. 

Thrice  I  have  observed  fetal  retention  due  to  adhesive 
inflammation  in  the  cervices  of  heifers.  In  one,  the  fetus 
had  not  been  long  dead  and  the  cervical  canal  admitted  the 
hand.  Traction  upon  the  fetus  ruptured  the  cervix.  The 
heifer  recovered  her  general  health  and  was  sold  for  beef. 
In  the  second  case,  the  fetus  macerated  and  sloughed  into 
the  rumen,  and  the  animal  recovered  sufficiently  to  be  sold 
for  beef.  The  third  was  neglected  until  the  eight-months 
fetus  had  been  dead  seven  or  eight  months.  The  cervix  was 
dilated  by  cutting  the  first  annular  ring  and  most  of  the 
fetal  cadaver  removed.  Two  fetal  bones  were  later  removed 
by  laparotomy  and  hysterotomy.  The  animal  recovered  her 
general  health  and  condition. 

So  far  as  I  have  seen,  the  partial  atresia  of  the  canal  has 
been  in  the  first  or  in  the  first  and  second  rings.  All  cases 
have  been  in  heifers  in  first  pregnancy  and,  so  far  as  known, 
death  of  the  fetus  has  occurred  prior  to  any  eff'ort  at  expul- 
sion. Apparently  the  infection  within  the  cervix  has  ex- 
tended into  the  uterus,  involved  the  fetus  and  caused  its 
death.  In  two  of  the  three  cases  no  effort  to  expel  the  fetus 
was  noted  by  the  owner. 

The  cases  off"er  a  very  bad  prognosis  from  the  standpoint 
of  reproduction,  but  the  outlook  for  the  restoration  of  the 
general  health  is  fair.  As  a  rule  it  is  desirable  or  necessary 
to  dilate  the  cervical  canal  by  incising  the  first,  or  first  and 
second  annular  rings.  Then  pituitary  extract  may  be  given 
(5  to  10  mils  of  the  Parke,  Davis  &  Co.  preparation  or  its 
equivalent  of  other  makes)  in  an  effort  to  cause  efficient 
uterine  contraction  to  expel  the  fetus.  Additional  aid  should 
be  given  according  to  indications. 

Once  the  fetus  has  been  extracted,  the  cervix  should  be 
given  close  attention  and  healing  facilitated.  The  cervix  is 
too. grossly  infected  for  tracheoplasty  at  the  time.  If  the 
patient  is  of  but  ordinary  value,  the  cervix  and  uterus  had 
best  be  kept  clean  and  disinfected  until  the  general  condi- 
tion has  been  restored,  and  the  animal  then  sold  for  slaugh- 
ter. If  highly  valuable,  partial  trachelectomy  should  be 
performed. 

41 


642  Diseases  of  the  Ge?iital  Orgaris 

D.  Retention  Cysts  of  the  Cervix. 
Cysts  occur  somewhat  rarely  in  the  vaginal  end  of  the 
cervix  about  the  os  uteri  externum.  I  have  observed  them 
at  the  sides  of  the  opening  of  the  cervical  canal.  They  vary 
in  size  from  one-half  to  one  inch  in  diameter.  They  ordi- 
narily contain  mucus,  which  sometimes  becomes  infected 
and  purulent.  They  are  apparently  retention  cysts.  It  has 
been  my  habit  to  incise  these,  when  encountered,  and  cau- 
terize their  interior  with  full  strength  Lugol's  solution  or 
with  silver  nitrate. 

E.  Cervical  Prolapse. 

Prolapse  of  the  cervix  consists  of  a  displacement  of  the 
cervix  toward  or  through  the  vulva.  It  inevitably  involves 
a  simultaneous  displacement  of  the  base  of  the  uterus  and 
of  the  cervical  end  of  the  vagina  toward  the  vulva.  It  is 
possible  in  the  non-pregnant  heifer.  It  is  observed  during 
pregnancy  and  at  varying  periods  after  its  termination. 

The  symptoms  of  cervical  prolapse  are  too  evident  to  call 
for  detailed  description.  As  a  rule  the  prolapse  becomes 
evident  only  while  the  cow  is  recumbent.  It  then  appears 
as  a  conical  tumor,  with  its  base  directed  forward  and  its 
obtuse  apex  toward  or  beyond  the  vulva.  In  or  near  the 
center  of  the  obtuse  apex  is  a  depression,  the  os  uteri  ex- 
ternum. The  vulvar  end  of  the  cervix  becomes  increasingly 
swollen  and  irritated  according  to  the  degree  and  duration 
of  protrusion.  When  protruding  beyond  the  vulva  suffi- 
ciently to  come  into  contact  with  the  bedding  and  with  feces 
or  other  contaminating  substances,  the  swelling  and  irrita- 
tion increase.  The  irritation  may  reach  such  a  degree  as  to 
cause  an  excessive  secretion  of  mucus,  or  suppuration  and 
necrosis  of  the  mucosa  may  occur. 

In  the  pregnant  animal  the  uterine  seal  is  usually  present 
but  imperfect  and  showing  varying  degrees  of  disease.  The 
two  chief  causes  of  prolapse  of  the  cervix  are  disease  of  the 
uterine  end  of  the  cervical  and  of  the  uterine  mucosa  and  a 
general  atony  of  the  genital  system.  In  the  first  group  of 
cases,  so  far  as  I  have  yet  been  able  to  observe.  i\\v  primary 


Cervical  Prolapse  643 

cause  is  an  endometro-cervicitis.  Both  the  endometrium 
and  the  endocervical  mucosa  become  inflamed  and  irritated 
in  such  a  manner  that  abdominal  pressure  is  brought  to  bear 
upon  the  pelvic  contents.  When  the  animal  lies  down  there 
is  added  a  passive  intra-abdominal  compression  which 
pushes  uterus,  cervix  and  vagina  backward.  The  muscular 
walls  of  the  cervix  retain  their  tone  or  are  rigid  from 
disease;  the  uterine  walls  are  atonic.  In  the  pregnant 
animal  the  fetus  and  its  membranes  are  not  expelled 
because  the  cervix  does  not  relax  and  the  uterine  walls 
do  not  contract,  to  compel  the  dilation  of  the  canal. 
Consequently  the  cervix  is  displaced  backward.  In 
other  instances,  in  pregnant  animals,  the  expulsion  of  the 
fetus  is  inhibited  by  induration  of  the  cervical  walls  with 
adhesions  which  prevent  that  degree  of  dilation  essential  to 
the  expulsion  of  the  uterine  contents.  During  the  post- 
parturient  period,  without  nymphomania,  cervical  prolapse 
is  ordinarily  dependent  upon  a  quite  severe  endometritis 
associated  with  a  lingering  placental  necrosis.  In  the  second 
group  of  cases,  the  displacement  is  fundamentally  due  to 
uterine  atony  dependent  upon  that  type  of  ovarian  disease 
regularly  causing  nymphomania.  In  these  cases  the  cervix 
is  relaxed  and  its  canal  will  permit  of  the  ready  passage  of 
one,  two  or  more  fingers.  The  progress  of  cervical  prolapse 
is  very  slow.  In  the  pregnant  animal  it  tends  to  become 
worse  as  time  for  parturition  approaches.  Each  time  that 
the  cervix  pushes  out  beyond  the  vulva  while  the  patient  is 
recumbent,  the  protruding  mass  becomes  soiled  with  litter, 
increasing  the  irritation  and  the  volume  of  the  tumor,  which 
in  turn  cause  greater  straining  and  protrusion.  Eventually, 
if  the  animal  calves,  the  unloading  of  the  uterus  usually 
causes  the  protrusion  to  disappear.  When  endometritis 
causes  cervical  prolapse  in  a  non-pregnant  cow,  the  pro- 
lapse tends  constantly  to  increase.  The  prolapse  of  the  cer- 
vix, with  the  displacement  of  the  uterus,  imprisons  the  irri- 
tant secretions  within  the  uterus.  The  cervical  prolapse  as- 
sociated with  nymphomania  usually  disappears  when  the 
cystic  condition  of  the  ovaries  is  brought  under  control. 


644  Diseases  of  the  Genital  Organs 

The  prognosis  of  cervical  prolapse  is  generally  unfavor- 
able, because  the  underlying  causes  are  not  often  easy  to 
remove.  In  the  pregnant  animal  the  prolapse,  with  the  as- 
sociated cervicitis,  not  infrequently  renders  parturition, 
abortion  or  extraction  of  the  fetus  difficult  and  imperils  the 
life  of  the  patient  through  sepsis  or  pyemia.  The  cervical 
prolapse  in  nymphomania  indicates  a  serious  type  of  ovarian 
disease,  which  is  aggravated  by  the  prolapse. 

The  handling  varies  according  to  the  state  of  the  patient 
and  the  underlying  cause.  In  the  pregnant  animal  it  should 
be  determined  first  whether  the  fetus  is  alive.  This  is  best 
accomplished  by  rectal  palpation.  The  fetus  is  usually  pal- 
pable and  some  part  of  it  can  be  grasped.  When  pressure  or 
traction  is  exerted  upon  a  fetal  part,  if  alive,  the  fetus  al- 
most invariably  attempts  to  pull  the  extremity  away.  If 
the  fetus  is  alive,  the  handling  should  be  purely  palliative 
and  an  earnest  effort  made  to  get  the  diseased  parts  in  the 
best  possible  condition  for  the  eventual  expulsion  or  ex- 
traction of  the  fetus.  For  this  purpose  the  vulvar  sutures 
described  under  Vaginal  Hernia  in  Chapter  V,  and  illus- 
trated in  Fig.  60,  can  be  made  to  serve  the  highly  useful 
purpose  of  retaining  the  cervix  within  the  vagina  and  pro- 
tecting it  against  the  irritating  effects  of  desiccation  when 
exposed  to  the  air,  and  from  becoming  contaminated  through 
contact  with  bedding  and  filth.  It  is  best  to  use  heavy  silver 
wire  and  secure  the  apposition  of  the  vulvar  lips  by  merely 
hooking  the  free  ends  of  one  side  over  the  wire  of  the  other. 
Then,  if  parturition  begins  in  the  absence  of  the  attendant, 
the  force  unbends  the  hook  and  releases  the  suture.  At  the 
same  time  any  existing  inflammation  may  be  ameliorated  by 
douching  the  vagina,  and  that  portion  of  the  cervix  project- 
ing into  it,  with  warm  0.25  per  cent.  Lugol's  solution  or 
saturated  boric  acid  solution,  or  by  applying  to  the  parts  an 
ointment  of  bismuth  subnitrate,  iodoform  and  petrolatum. 
While  dressing  the  parts  the  sutures  should  be  released  in 
order  that  the  fluids  may  be  freely  expelled. 

When  time  for  parturition  arrives,  if  the  cervix  is  loo  dis- 
eased to  permit  efficient  bloodless  dilation.  Ihe  conslrictod 


Infections  of  the  Vagina  645 

portion  of  the  cervix  may  be  incised  or  abdominal  hyster- 
otomy performed.  If  the  cow  is  highly  valuable  for  breed- 
ing purposes,  hysterotomy  is  perhaps  preferable  as  a  rule. 
The  operation  has  been  described  in  the  companion  volume, 
Veterinary  Obstetrics.  After  recovery  from  the  operation, 
the  cervicitis  underlying  the  difficulty  is  to  receive  proper 
attention.  Usually  a  partial  or  complete  amputation  of  the 
cervix  is  indicated.  If  the  animal  has  no  unusual  breeding 
or  dairying  value,  the  dilation  of  the  cervix  by  incision  may 
be  simpler  and  the  animal  may  make  a  prompter  recovery, 
so  far  as  her  general  health  is  concerned,  but  the  cicatrix  in 
the  cervix  probably  leaves  her  unfit  for  breeding.  However, 
the  mutilated  cervix  may  be  successfully  amputated  later  if 
found  desirable.  In  the  non-pregnant  cow,  when  the  pro- 
lapse is  due  to  intra-uterine  infection,  the  cervical  canal  is 
to  be  sufficiently  dilated  to  admit  readily  the  uterine  cathe- 
ter. The  uterus  is  then  to  be  douched  with  0.25  to  2  per 
cent.  Lugol's  solution  or  other  disinfectant,  and  bismuth 
and  iodoform  suspended  in  oil  introduced.  The  handling 
should  be  repeated  at  intervals  of  one  to  three  weeks  until 
recovery  is  assured.  When  the  prolapse  is  referable  to 
nymphomaniac  cysts  in  the  ovaries,  the  fundamental  plan  of 
handling  already  advised  for  nymphomania  is  to  be  applied, 
with  special  attention  to  the  uterus  and  cervix. 

7.    Infections  of  the  Vagina 

A.  Vaginitis 

Vaginitis  is  induced  in  many  ways.  The  nodular  venereal 
disease,  most  clearly  and  readily  recognized  in  the  vulva, 
commonly  extends  into  the  vagina  and  is  revealed  by  lesions 
identical  with  those  in  the  vulva.  This  has  already  been  de- 
scribed. Reference  has  also  been  made  to  vaginitis  caused 
by  the  vesicular  venereal  disease,  coital  injuries,  and 
sadism. 

Vaginitis  commonly  follows  parturition  and  abortion. 
Primarily  parturition  and  abortion  cause  more  or  less  se- 
vere contusions  and  abrasions.  The  great  pressure  under 
which  the  fetus  is  forced  through  the  vagina  destroys  much 
of  the  protective  epithelium,  and  so  injures  the  underlying 
tissues  that  hemorrhages  are  common.    The  lesions  are  so 


646  Diseases  of  the  Genital  Organs 

nearly  universal  that  they  may,  in  a  sense,  be  designated  as 
normal.  In  themselves  such  injuries  are  unimportant.  They 
acquire  interest  through  the  fact  that  they  afford  inviting 
avenues  for  infection.  The  abrasions  and  contusions  of  the 
vagina  are  often  aggravated  in  cases  of  dystocia  by  the  im- 
prudent and  careless  use  of  harsh,  dirty  cords  or  other  ap- 
pliances. 

If  the  fetal  membranes  are  retained  and  decompose,  the 
virulent  infection  present  readily  invades  the  injured  tis- 
sues. When  infection  exists  within  the  uterus  and  passes 
out  through  the  vagina,  it  endangers,  in  passing,  the  dam- 
aged tissues.  In  metritis  quite  commonly  the  highly  infec- 
tive secretions  of  the  uterus  are  promptly  expelled  into  the 
vagina  and  lie  there  for  hours  before  the  expulsion  from  the 
genital  canal  is  completed,  constantly  irritating  the  mucosa. 
One  of  the  commonest  and  most  serious  types  of  vaginitis 
is  that  caused  by  imprudent  or  clumsy  attempts  at  douching. 
Some  laymen  think  that  they  may  control  "contagious  abor- 
tion" by  vaginal  douching.  Other  laymen  think  that,  when 
douching  the  vagina,  they  are  douching  the  uterus.  Many 
publications  by  technically  scientific  persons  advise  the  use 
of  powerful  disinfectants  in  the  vagina.  Frequently  the 
teaspoon  is  advised  as  a  standard  of  measurement,  although 
teaspoons  vary  greatly  in  size  and  both  solids  and  liquids 
may  be  heaped  up  in  varying  degrees,  or  some  of  the  disin- 
fectant may  run  over  into  the  water.  Sometimes  a  slow- 
dissolving  salt,  such  as  permanganate  of  potash,  is  advised 
and  douching  is  attempted  before  the  crystals  are  dissolved. 
The  heavy  crystals  may  drop  down  upon  the  vaginal  floor 
and  cause  necrosis.  The  vaginal  mucosa  is  extremely  vul- 
nerable to  disinfectants.  Solutions  borne  with  impunity  by 
the  uterus  and  vulva  are  intolerable  for  the  vagina.  This 
must  always  be  borne  in  mind  in  douching.  Whenever  the 
douche  is  so  irritant  that  it  causes  distress,  it  is  injuring  the 
organ  and  should  not  be  used.  Vaginitis  is  common  as  an 
extension  by  continuity  of  cervicitis,  especially  in  purulent 
cervicitis  involving  the  vaginal  end.  Vaginitis  usually  fol- 
lows coitus  in  heifers  badly  affected  with  the  nodular  vene- 
real disease.    The  exacerbation  of  the  infection  follows  coi- 


Vaginal  Gangrene  647 

tus  in  twenty-four  to  forty-eight  hours.  However  vagi- 
nitis may  arise,  the  general  principles  of  handling  demand 
the  elimination  of  the  cause,  followed  by  the  application  of 
those  measures  which  may  allay  the  irritation.  If  the  vagi- 
nitis is  a  consequence  of  severe  metritis  or  cervicitis,  these 
must  lirst  be  brought  under  control  before  any  progress  can 
be  made  in  overcoming  the  vaginal  lesions.  When  vaginitis 
is  dependent  upon  chemical  irritants,  such  as  too  powerful 
disinfectants,  they  are  to  be  promptly  withdrawn  and  sooth- 
ing applications  substituted.  Of  these,  douches  of  warm  0.7 
per  cent,  salt  solution  (1  oz.  salt  to  1  gal.  boiled  water)  have 
probably  the  greatest  value.  In  some  cases  0.25  per  cent, 
of  LugoFs  solution,  or  2  to  4  per  cent,  boric  acid  may  be  ad- 
vantageously added.  When  irritant  disinfectants  have  been 
introduced,  causing  denudation  of  the  epithelium,  a  heavy 
ointment  or  an  oil,  like  liquid  paraffin  with  iodoform,  sub- 
nitrate  of  bismuth,  or  both  may  be  applied  with  benefit. 
Here  every  effort  should  be  made  to  counteract  the  chief 
peril — vaginal  atresia.  This  object  will  be  furthered  by 
dilating  the  vagina  daily  with  the  warm  saline  solution,  fol- 
lowed by  the  oil  or  ointment  with  iodoform,  etc. 

The  intense  vaginitis  often  following  coitus  in  heifers  is 
best  prevented  by  douching  the  vagina  six  to  twelve  hours 
after  coitus  with  0.25  per  cent.  Lugol's  solution,  repeating 
in  twenty-four  hours  if  necessary. 

B.  Vaginal  Gangrene. 
There  appear  from  time  to  time  records  of  vaginal  gan- 
grene in  cows  during  the  puerperal  period.  In  some  in- 
stances the  records  almost  suggest  a  special  or  specific  type 
of  infection,  but  there  is  nothing  definite  upon  which  to  base 
a  conclusion.  In  the  presence  of  an  intense  infection  of  the 
cervix  or  uterus,  associated  perhaps  with  retained  fetal 
membranes  and  extensive  parturient  abrasions  in  the  vagi- 
nal walls,  gangrene  of  the  vagina  is  always  a  possibility. 
The  tendency  to  gangrene  is  increased  by  rough  work  in  re- 
lieving dystocia  and  by  the  use  of  highly  irritant  vaginal 
douches.  Although  it  may  sound  paradoxical,  one  of  the 
easiest  ways  to  cause  vaginal  gangrene  is  by  the  misuse  of 
powerful  antiseptics. 


648  Diseases  of  the  Genital  Organs 

The  symptoms  consist  chiefly  of  vulvar  swellings,  profuse 
genital  discharge,  straining  and  general  evidences  of  pain. 
The  discharge  is  often  fetid.  Manual  examination  causes 
intense  pain.  The  vaginal  walls  are  greatly  swollen,  render- 
ing the  introduction  of  the  hand  difficult.  Portions  of  the 
mucosa  are  partly  detached  or  are  very  fragile.  By  spread- 
ing apart  the  vulvar  lips,  dark,  necrotic  areas  may  be  ob- 
served. 

Nothing  of  special  value  has  been  learned  regarding  the 
bacteriology  of  the  disease.  As  in  other  types  of  genital  in- 
fections, it  appears  that  in  certain  herds  at  a  given  time 
some  one  form  of  bacterium  acquires  special  intensity  and 
induces  a  prevalent  type  of  lesions. 

The  handling  of  gangrenous  vaginitis  calls  first  of  all  for 
the  control  of  uterine  and  cervical  infections.  I  have  ob- 
served very  energetic  efforts  to  control  gangrenous  vaginitis, 
while  imprisoned,  decomposing  fetal  membranes  which  were 
the  basic  cause  were  overlooked.  The  vagina  itself  should 
be  cleansed  by  the  gentlest  available  measures,  essentially 
those  mentioned  above  for  vaginitis. 

C.  Perivaginal  Phlegmon. 

Parturient  contusions  and  abrasions  open  the  way  for 
the  invasion  of  infection  from  the  genital  tube  into  the  pel- 
vic connective  tissues.  Once  the  infection  passes  the  barrier 
of  the  vaginal  walls  and  gains  the  very  loose,  open  areolar 
tissue  of  the  pelvis,  it  tends  to  spread  with  great  rapidity. 
The  progress  of  the  infection  is  often  so  rapid  that  the  tis- 
sues are  unable  to  erect  any  efficient  barrier  and  suppura- 
tion or  gangrene  advances  rapidly.  Sometimes  imperfect 
abscess  walls  are  formed  which  offer  no  important  degree  of 
resistance. 

The  contusions  and  abrasions  are  much  the  same  as  those 
producing  vaginitis,  but  act  more  upon  the  deeper  tissues. 
In  some  cases  the  prominent,  conical,  bony  projection  at  the 
anterior  end  of  the  pubic  symphysis  plays  an  essential  part 
in  causing  the  original  contusion.  The  vaginal  floor  becomes 
impinged  between  the  summit  of  the  cone  and  some  hard 
portion  of  the  fetus;  in  some  instaiu-es  liu>  vagina  becomes 


Crsfs  and  Abscesses  of  Giirtuer  s  Ducts  649 

actually  perforated.  The  infection  then  readily  passes  out 
into  the  adjacent  tissues.  The  invasion  of  the  pelvic  con- 
nective tissues  causes  swelling  of  the  vulva  and  anus,  with 
evidences  of  pain.  Usually  the  patient  moves  carefully  and 
hesitatingly,  the  appetite  is  poor,  and  the  rectal  tempera- 
ture may  be  elevated.  Vaginal  or  rectal  palpation  discloses 
more  or  less  extensive  swellings  in  the  pelvis  surrounding 
the  vagina.  At  some  points  collections  of  fluid  (thin  pus) 
are  recognizable,  but  there  are  no  clearly  defined  limiting 
walls. 

The  course  of  such  infection  is  usually  rapid.  As  a  rule 
the  patient  succumbs,  largely  because  the  tissues  fail  to  form 
a  barrier  sufficient  to  prevent  the  highly  virulent  masses  of 
pus  from  invading  the  peritoneal  cavity.  If  the  infection 
is  not  too  virulent,  abscessation  may  occur  and  the  abscess 
may  open,  or  be  surgically  opened,  into  the  vagina  or  rec- 
tum. It  then  has  the  common  significance  of  pyemia  as 
described  under  infections  of  the  uterus.  The  invasion  may 
sometimes  be  anticipated  if  the  parturient  abrasions  are 
recognized  early.  The  genital  tract  may  then  be  cleansed 
and  iodoform  with  oil  introduced  into  the  uterine  cavity. 
This,  flowing  slowly  over  the  abraded  parts,  may  deter  pu- 
trefaction and  bacterial  invasion.  Once  established,  the 
phlegmon  is  difficult  to  control.  Repeated  warm  vaginal 
douches  of  saline  solution  may  aid  in  checking  the  infection. 
Internal  remedies,  such  as  quinine,  may  be  tried,  but  they 
offer  little  hope. 

D.  Cysts  and  Abscesses  of  Gartner's  Ducts. 
Gartner's  ducts,  described  on  page  39,  are  frequently  the 
seat  of  retention  cysts  and  abscesses.  These  occur  along  the 
course  of  the  ducts,  as  shown  in  Figs.  18-21.  They  vary  in 
form  and  extent,  but  are  usually  elongated,  with  a  trans- 
verse diameter  of  one-half  inch  or  less.  They  may  be  very 
large  and  spherical.  They  are  of  comparatively  little  impor- 
tance except  as  reminders  of  the  presence  of  infections 
which,  invading  the  duct,  cause  atresia  of  its  opening,  with 
cystic  or  purulent  distension.  Rarely  they  may  attain  such 
size  as  to  interfere  with  coitus.   When  recognized,  the  cysts 


650  Diseases  of  the  (lenital  Organs 

or  abscesses  should  be  laid  open  freely  and  the  parts  disin- 
fected. 

8.  The  Infections  of  the  Vulva 

The  vulva  is  the  most  prominent  area  involved  in  the  vesi- 
cular, and  in  the  nodular  venereal  diseases,  as  has  been  noted 
already  in  Chapter  XII.  The  vulva  also  participates  in  a 
general  way  in  parturient  abrasions  of  the  vagina  and  the 
consequent  infections,  which  run  a  similar  course  and  call 
for  similar  handling.  The  vulva  now  and  then  undergoes 
gangrene,  especially  following  neglected  dystocia,  when  the 
organ  has  been  subjected  to  long-continued  pressure  and 
contusion  from  the  fetus.  Then  follows  at  times  cicatricial 
contractions  rendering  coitus  and  parturition  difficult  or 
impossible. 

In  some  portions  of  the  Mississippi  Valley  at  one  time  an 
infectious  ano-vulvitis  of  cattle  prevailed,  not  associated 
with  reproduction.  It  consisted  of  a  necrotic  inflammation 
of  the  anus  of  the  male  and  of  the  anus  and  vulva  of  the 
female.  The  mortality  was  high  and  in  non-fatal  cases  im- 
portant deformity  of  the  body  openings  resulted. 

The  exact  cause  of  the  disease  was  not  clearly  determined. 
It  was  referred  generally  to  an  invasion  by  the  bacillus  ne- 
crophorus,  which  apparently  serves  as  a  general  designation 
for  necrotic  diseases  occurring  in  various  parts  of  the  body 
in  different  species  of  animals,  but  not,  so  far  as  known, 
transmissible  from  one  species  to  another. 

The  ano-vulvitis  of  cattle,  which  occurs  as  an  enzootic,  is 
of  chief  interest  in  connection  with  its  general  results  rather 
than  in  connection  with  reproduction.  The  disease  ordina- 
rily arises  without  a  known  injury  to  the  parts,  as  a  necro- 
tic area  about  the  anus  or  vulva.  The  necrosis  is  progres- 
sive, the  parts  become  swollen  and  indurated,  and  the  sur- 
face undergoes  extensive,  canker-like  necrosis,  with  the 
formation  of  fetid  pus. 

The  handling  has  not  been  placed  upon  a  definite  basis  as 
a  specific  disease,  but  reliance  has  been  placed  ui)on  the  gen- 
eral principles  of  surgery — the  destruction  or  ablation  of 
incurable  tissues,  the  disinl'ection  of  the  invohcMl  areas,  and 
the  isolation  of  infected  animals. 


III.    THE  CONGENITAL  INFECTIONS  OF  CALVES 

Calf  Septicemia,  Calf  Dysentery,  Dysentery  Neonatorum, 

Calf  Scours,  White  Scours,  Pyemic  Arthritis, 

Joint  111,    Calf  Pneumonia 

While  considering  the  infections  of  the  ovum,  embryo  and 
fetus,  it  was  pointed  out  that  both  the  pregnant  and  the  non- 
pregnant uterus  commonly  contain  bacteria  of  various 
kinds,  and  that  in  the  pregnant  cow  these  invade  the  fetal 
membranes,  enter  the  amniotic  fluid,  are  swallowed  by  the 
embryo,  and  constitute  a  part  of  the  meconium.  Generally 
the  bacteria  are  included  in  the  meconium,  though  they 
cause  no  recognizable  disease  of  the  fetus,  but  in  numerous 
cases,  associated  especially  with  the  phenomenon  of  abor- 
tion, they  cause  diarrhea  and  sepsis. 

Birth  can  not  serve  as  a  line  of  demarcation  between  the 
infections  of  ante-  and  post-natal  life.  Non-fatal  infections 
of  the  fetus  inevitably  involve  the  new-born  calf.  More  gen- 
erally the  bacteria  included  within  the  meconium  at  the  time 
of  birth  remain  for  a  time  as  bacterial  inclusion  rather  than 
infection,  and  may  at  any  period  subsequent  to  birth  acquire 
force  and  cause  disease.  Accordingly  calves  show  a  very 
wide  range  of  disease  phenomena  referable  to  intra-uterine 
infection.  The  clinical  symptoms  and  postmortem  lesions 
do  not  admit  of  the  division  of  these  results  of  infection 
into  distinct  diseases  having  separate  causes  and  histories : 
the  various  types  pass  imperceptibly  one  into  the  other. 
Neither  can  intra-uterine  infections  be  definitely  separated 
from  post-natal  invasions.  An  infection  emanating  from 
the  uterus  of  a  cow  and  swallowed  by  her  fetus  may  with 
equal  facility  be  swallowed  by  her  new-born  calf  when  the 
liberated  uterine  discharges  flow  down  the  thighs  of  the 
cow  and  reach  the  teat  which  the  calf  sucks.  Neither  can 
there  well  be  any  fundamental  difference  in  results,  whether 
a  bacterium  is  swallowed  by  the  fetus  or  is  taken  into  the 
.alimentary  tract  of  the  calf  shortly  after  birth.  Varying 
types  of  disease  phenomena  occur,  the  fundamental  cause 
of  which  is  the  same,  so  far  as  known.   When  the  uterus  of 


652  Diseases  of  the  (knital  Organs 

a  pregnant  cow  is  intensely  infected,  the  fetus  inevitably 
participates  in  a  large  degree.  If  the  fetus  resists  the  in- 
fection with  such  success  that  it  is  born,  the  birth  may  be 
very  tardy  owing  to  the  paresis  of  the  uterus  due  to  the 
metritis  present.  The  fetal  membranes  may  be  retained. 
Often  the  uterus  contracts  so  feebly  that  traction  must  be 
applied  to  the  fetus.  Sometimes  the  feeble  action  of  the 
uterus,  or  illness  of  the  fetus,  or  the  two  combined,  pre- 
vents the  fetus  from  vigorously  assuming  the  proper  posi- 
tion for  birth,  the  head  or  a  limb  deviates  from  its  correct 
course,  and  dystocia  results.  Finally,  if  the  fetus  survives 
and  is  born,  it  is  ill.  It  may  be  smeared  over  with  meconium, 
indicating  that  as  a  fetus  it  suffered  from  diarrhea.  The 
calf  is  weak  and  listless.  It  can  not  get  up  and  perhaps  can 
not  stand  if  lifted  to  its  feet.  It  may  or  may  not  have  diar- 
rhea. The  rectal  temperature  may  be  abnormal,  normal,  or 
subnormal.  The  calf  may  rally  after  a  time  and  get  up,  but 
usually  the  depression  increases  and  after  two  or  three  to 
twenty-four  hours  it  dies.  Autopsy  reveals  hemorrhages 
in  the  liver,  spleen,  or  other  viscera,  or  beneath  the  pleura 
or  peritoneum.  The  lesions  are  essentially  identical  with 
those  observed  in  aborts.  One  animal  dies  within  the  uterus 
and  is  expelled  shortly  afterward ;  the  other  is  alive  when 
expelled  from  the  uterus  but  soon  perishes.  The  difference 
between  the  two  is  merely  the  time  and  place  when  death 
occurs.   The  cause  and  origin  are  the  same  in  both  cases. 

The  dysentery  of  calves  has  not  been  clearly  defined.  It 
merges  imperceptibly  in  one  direction  with  calf  septicemia, 
is  inseparably  linked  with  calf  pneumonia,  is  complicated 
by  arthritis  and  other  pyemic  disturbances,  and  can  not  be 
separated  by  any  clear  line  of  demarcation  from  lesser  dis- 
turbances which  can  not  be  included  under  either  of  the 
types  mentioned.  Like  calf  septicemia,  dysentery  of  calves 
is  a  type  of  infection,  -or  group  of  infections,  rather  than  a 
specific  infectious  disease.  Clearly  due  to  infection,  it  is 
not  known  to  be  due  to  any  one  disease-producing  organism. 
Though  it  is  known  that  several  organisms  may  be  recog- 
nized associated  with  the  diarrhea,  the  exact  part  in  the 
disease  played  by  any  one  of  the  bacteria  is  unknown. 


Cojigenital  Infections  of  Calves  653 

Calf  dysentery  has  long  been  a  fruitful  field  of  contro- 
versy as  to  cause.  Its  intelligent  study  has  been  held  back 
largely  by  false  theories  as  to  its  nature.  Many  have  held 
that  it  was  due  wholly  and  directly  to  improper  feeding, 
and  the  claim  has  been  so  often  repeated  that  it  has  ac- 
quired the  weight  of  a  fact.  Some  also  taught  that  it  was 
due  entirely  to  navel  infection,  and  this,  too,  became  a  com- 
mon belief.  All  prophylactic  and  curative  efforts  based  upon 
either  of  these  beliefs  came  to  naught,  and  when  these  er- 
roneous theories  had  failed  the  truth  largely  went  unsought. 
The  theories  mentioned  above  belittled  the  significance  of 
dysentery  in  calves.  If  merely  a  matter  of  feeding,  any 
person  of  moderate  intelligence  should  readily  control  it. 
If  due  wholly  to  navel  infection,  ordinary  cleanliness  would 
obviate  the  difficulty.  It  was  therefore  technically  an  un- 
important affair  from  the  standpoint  of  the  pathologist  and 
a  virtually  hopeless  scourge  from  the  viewpoint  of  the 
breeder  whose  calves  were  persistently  dying. 

Calf  dysentery  is  slowly  becoming  recognized  as  one  of 
the  links  in  an  endless  chain  of  infection  invading  the  geni- 
tal organs  of  breeding  cattle  of  both  sexes,  passing  over 
from  the  uterus  of  the  pregnant  cow  to  the  digestive  tract 
of  the  embryo  within  her  uterus,  and,  under  favorable  en- 
vironment, capable  of  causing  retained  afterbirth  in  the 
mother,  or  serious  or  fatal  sepsis,  dysentery  and  pneu- 
monia in  the  calf,  or  of  escaping  from  the  digestive 
tract  to  invade  permanently  other  systems  or  organs. 
Under  this  broader  conception,  the  dysentery  of  calves 
becomes  an  integral  part  of  one  of  the  most  important 
diseases  among  domestic  animals.  The  term  is  commonly 
applied  to  a  diarrhea  or  dysentery  occurring  in  calves 
a  few  hours  to  a  few  days  after  birth.  Some  writers 
limit  the  period  to  the  interval  between  a  few  hours  to  three 
or  four  days  after  birth.  Diarrhea  occurring  in  calves  at 
other  times  is  otherwise  designated,  but  the  line  of  demarca- 
tion is  not  clear  and  the  limitation  to  such  a  period  as  indi- 
cated is  purely  arbitrary. 

Diarrhea  is  common  in  the  fetus.    Physiologically,  as  soon 


654  Diseases  of  the  Geiiital  Organs 

as  the  alimentary  tract  is  formed  and  the  pharynx  opens, 
the  fetus  commences  to  swallow  but  does  not  defecate.  The 
amniotic  fluid  is  constantly  swallowed  along  with  any  ex- 
foliated epidermic  scales  or  other  solids  suspended  in  the 
fluid.  Before  hairs  are  macroscopically  visible,  meconium 
examined  under  a  low-power  lens  reveals  tiny  short  hairs 
which  have  been  shed  and  then  swallowed.  Bacteria  which 
have  invaded  the  amniotic  fluid  are  also  swallowed.  The 
swallowed  liquor  amnii  is  promptly  absorbed  by  the  intes- 
tines, enters  the  fetal  lymph  or  blood  stream,  and  later  pre- 
sumably returns  to  the  amniotic  sac.  The  solids,  such  as 
hairs,  bacteria  and  epithelial  scales,  remain  behind  in  the 
intestinal  canal  as  in  a  cesspool,  to  constitute  the  meconium. 
Since  physiologically  the  fetus  does  not  defecate  and  con- 
stantly swallows  its  amniotic  fluid,  filtering  it  through  the 
intestinal  walls,  it  follows  that  this  is  regularly  clear,  while 
the  allantoic  fluid  is  frequently  turbid. 

But  the  fetus,  like  the  living  calf,  does  not  always  travel 
serenely  along  the  physiologic  path.  Nearly  half  the  uteri 
of  pregnant  abattoir  cows  contain  bacteria  which  have  the 
power  to,  and  do  penetrate  the  chorion,  contaminate  the  am- 
niotic fluid,  and  are  swallowed  by  the  fetus.  There  are 
found,  thus  swallowed,  streptococci,  colon  bacilli,  micro- 
cocci, B.  abortus,  and  other  bacteria.  Physiologically  this 
should  not  be.  Their  presence  does  not  necessarily  cause  dis- 
aster. Up  to  a  considerable  volume  the  walls  of  the  cesspool 
— the  alimentary  epithelium — perhaps  aided  by  the  biliary 
or  other  secretions  and  probably  favored  by  the  marked 
desiccation  of  the  meconium,  render  powerless  the  bacteria 
present. 

The  power  of  the  fetal  intestine,  like  that  of  the  adult,  ha^ 
its  limitations.  If  the  volume  of  bacteria  is  too  great,  or 
the  virulence  too  high,  the  restraining  power  of  the  intes- 
tine may  break  down.  If  the  fetus  is  weakened,  owing  to  a 
disturbance  of  its  nutrition,  its  control  over  resident  infec- 
tion may  be  lost.  Thus,  when  placentitis  is  present,  the  nu- 
trition of  the  fetus  is  crippled  and  harmful  products,  due 
to  the  infection  in  the  placenta,  reach  the  fetal  cirt'iilation. 


Congeiiital  Infections  of  Calves  655 

The  fetus  undergoes  partial  suffocation.  It  is  not  strange, 
therefore,  to  observe  that  aborts  frequently,  if  not  generally, 
suffer  from  diarrhea.  It  is  indeed  not  improbable  that 
dysentery  of  the  fetus  frequently  plays  a  vital  part  in  caus- 
ing fetal  death,  and  hence  abortion.  In  examining  aborts 
meconic  pellets  are  commonly  found  in  the  stomach :  that  is, 
prior  to  death  the  fetus  had  defecated  and  then  swallowed 
its  excrement. 

In  the  later  stages  of  pregnancy  fetal  diarrhea  is  not  rare. 
I  have  seen  many  gallons  of  diarrheic  feces  in  the  amniotic 
sac  at  the  time  of  expulsion  of  the  fetus.  More  commonly 
there  is  but  a  moderate  amount  in  the  amniotic  sac  and  the 
new-born  calf  is  thickly  smeared  over  with  soft,  sticky, 
brownish-yellow  feces. 

The  calf  which  has  suffered  in  the  uterus  from  dysentery, 
and  is  expelled  completely  covered  with  excrement,  is  fre- 
quently vigorous.  In  some  cases  calves  are  born  while 
dysentery  is  in  active  progress.  These,  under  careful  hand- 
ling, may  grow  vigorously. 

Most  cases  of  severe  dysentery  develop  within  a  few 
hours  to  a  few  days  after  birth,  but  no  time  limit  can  be 
fixed.  In  the  research  calves  of  my  department,  I  now  and 
then  see  an  acute  dysentery  after  ten  to  fifteen  days,  but 
these  cases  have  been  generally,  if  not  always,  relapses 
after  the  disease  has  been  brought  under  control  and  the 
calf  has  apparently  been  well  for  a  number  of  days.  So  far 
as  observed,  these  late  cases  were  etiologically  identical 
with  those  occurring  earlier.  Clinically  they  presented  the 
same  symptoms  and  reacted  in  the  same  manner  to  thera- 
peutic efforts. 

There  is  no  clear  line  of  demarcation  between  white  scours 
and  health.  At  one  extreme  is  the  ideally  healthy  calf;  at 
the  other,  the  calf  with  fatal  dysentery.  Between  these  two 
occur  every  possible  gradation  of  disturbance.  Neither  does 
there  exist  a  clear  line  of  demarcation  between  white  scours 
and  calf  pneumonia.  Clinically  the  two  glide  imperceptibly 
into  each  other,  and  etiologically  they  can  not  now  be  dif- 
ferentiated. 


656  Diseases  of  the  Genital  Organs 

The  etiology  of  calf  scours  has  not  been  clearly  deter- 
mined. Numerous  writers  regard  it  as  a  specific  contagious 
or  infectious  disease  having  one  bacillus  as  the  uniform 
causative  agent,  to  which  is  frequently  added  other  compli- 
cating organisms.  This  is  dithcult  to  prove  or  disprove.  It 
has  been  noted  already  that  diarrhea  is  common  in  abortion. 
Most  investigators  of  abortion  record  only  their  findings  re- 
garding the  B.  abortus.  They  state  generally  that  they  re- 
covered the  B.  abortus  from  the  alimentary  tract  of  the 
abort,  but  fail  to  state  whether  other  bacteria  were  present. 
According  to  our  investigations  the  B.  abortus  is  not  as  com- 
mon as  some  other  bacteria  in  the  utero-chorionic  space,  the 
fetal  alimentary  tract,  or  the  alimentary  tract  of  the  calf 
with  or  without  diarrhea. 

For  a  number  of  years  following  the  researches  of  No- 
card,  it  was  taught  that  calf  scours  was  due  to  a  bipolar 
bacillus  of  the  septicemia  hemorrhagica  group.  Later  Jen- 
sen and  others  taught — and  their  views  were  commonly  ac- 
cepted'— that  the  basic  cause  was  a  colon  bacillus.  My  col- 
league, Carpenter,  has  recently  presented  strong  evidence 
tending  to  show  that  a  streptococcus  of  the  viridans  group 
is  the  most  prominent  organism  present.  Micrococci  are 
common,  but  no  connection  between  them  and  dysentery  has 
been  traced.  Carpenter  has  generally  failed  to  identify  the 
colon  organism  in  the  intestinal  tracts  of  fetuses  and  of  sick 
calves  destroyed  before  death  was  imminent,  but  has  com- 
monly recovered  in  these  cases  the  streptococcus  of  the  viri- 
dans group.  Later  when  the  calf  is  apparently  dying,  or 
has  been  dead  for  a  few  hours  prior  to  the  making  of  cul- 
tures, the  colon  organism  becomes  very  conspicuous.  It  has 
been  frequently  asserted  without  qualification  that  dysen- 
tery in  calves  can  be  uniformly  produced  in  its  typical  form 
by  inoculating  with  the  colon  organism.  My  colleagues, 
Hagan  and  Carpenter,  have  repeatedly  tried  in  vain  to  cause 
dysentery  with  this  bacterium.  This  seemed  peculiar,  espe- 
cially since  Jensen  is  regularly  cited  as  having  proven 
clearly  by  experiment  the  specific  character  of  the  bacillus. 
A  critical  study  of  his  recordcnl  cxiKM-inicnts  c>xi)lains  at  least 


Congenital  Infections  of  Calves  657 

partly  the  apparent  contradiction  between  his  researches 
and  ours.  The  researches  of  Jensen  were  faulty  in  several 
respects : 

(1)  There  is  no  evidence  that  the  calves  selected  were 
free  from  alimentary  infection  when  born. 

(2)  Details,  or  even  general  outlines  of  the  feeding  are 
wholly  wanting. 

(3)  The  controls  had  diarrhea,  which  was  slower  in  de- 
veloping and  less  fatal  than  in  the  inoculated  animals,  but 
otherwise  showed  no  differential  characteristics. 

Accordingly  it  appears  that  the  conclusions  of  Jensen  were 
based  upon  wholly  unreliable  grounds  and  that  he  did  not  in 
fact  clearly  induce  dysentery  experimentally.  So  far  as  I  am 
aware,  calf  dysentery  can  not  be  caused  reliably  by  any 
known  bacterium,  although,  reasoning  by  analogy  and  view- 
ing it  clinically,  its  infectious  character  is  unquestionable. 
The  experimenter  is  faced,  as  in  abortion,  with  the  impossi- 
bility of  determining  in  advance  the  freedom  of  the  experi- 
mental animal  from  the  infection  under  consideration. 
When  there  is  added  the  utter  impossibility  of  clearly  de- 
fining white  scours,  the  difficulty  of  securing  definite  experi- 
mental data  upon  its  etiology  is  apparent.  The  conclusion 
can  not  well  be  avoided,  since  in  most  cases  of  calf  dysentery 
there  is  an  abundance  of  a  comparatively  limited  variety  of 
organisms  present,  and  those  recognized  are  reasonably  uni- 
form in  the  different  patients,  that  the  disease  is  due  to  in- 
fection, and  that  the  bacteria  multiplying  disastrously  in 
the  alimentary  tract  of  a  sick  calf  would  likewise  multiply, 
though  not  necessarily  disastrously,  when  properly  placed 
in  the  digestive  tract  of  another  calf.  Clinically  this  is  ap- 
parently true.  White  scours  breaks  out  in  large  stables  and 
pursues  the  relentless  course  of  a  scourge,  causing  a  mor- 
tality of  ten  to  one  hundred  per  cent,  for  months  at  a  time. 

Apparently  therapeutic  evidence  also  indicates  the  infec- 
tious character  of  the  disease,  though  this  may  be  mislead- 
ing. When  a  horse,  by  means  of  repeated  inoculations,  is 
rendered  highly  resistant  to  the  dominant  organism  asso- 
ciated with  white  scours,  his  blood  serum  injected  into  a 

42 


658  Diseases  of  the  GeyiHal  Organs 

calf  with  white  scours  generally  acts  specifically  to  ameli- 
orate the  disease.  I  have  found  no  record,  however,  of  any 
control  experiments  to  show  that  the  blood  serum  from  a 
horse  not  immunized  or  fortified  by  means  of  artificial  in- 
oculation with  the  organism  would  not  have  a  like  effect. 
A  more  direct  test  perhaps  is  the  use  of  killed  cultures  of 
artificially  grown  bacteria.  Limited  observations  seem  to 
indicate  that  these  act  specifically  under  conditions  not  yet 
fully  determined  and  may  give  to  the  calf,  under  some  con- 
ditions, a  more  enduring  resistance  to  diarrhea. 

Since  white  scours  is  not  clearly  defined,  its  symptoms 
can  not  be  accurately  described.  There  is  no  epoch  during 
which  the  line  of  demarcation  between  health  and  disease  is 
as  dim  and  hazy  as  in  young  calves.  The  healthy  calf,  when 
born,  has  a  glossy  brilliant  coat  of  hair,  soft  and  velvety  to 
the  touch;  its  body  is  of  even  contour  and  plump;  and  the 
calf  is  up  and  playing  in  an  hour  or  two.  Its  intestines, 
especially  the  rectum,  contain  a  pound  or  more  of  rather 
hard,  yellowish  or  greenish  to  greenish-black  meconium 
consisting  of  biliary  salts,  exfoliated  debris,  hairs,  and  fre- 
quently a  swarm  of  bacteria.  The  great  variation  in  size  of 
the  meconial  pellets,  in  their  adhesion  to  each  other,  and  in 
their  degree  of  desiccation,  sometimes  suggest  that  their 
character  is  largely  dependent  upon  the  quantity  and  nature 
of  the  infection  present.  Dysentery  may  exist  at  birth  or 
may  develop  at  any  hour  post-natal.  When  a  cow  or  heifer 
has  very  severe  infection  in  her  uterus,  the  fetus  when  born 
is  exceedingly  dull  and  languid.  It  is  unable  to  get  up  or  to 
stand  when  helped  to  its  feet.  Perhaps  no  diarrhea  is  pres- 
ent. It  may  in  fact  die  of  calf  septicemia.  If  death  is  held 
in  abeyance,  the  calf  generally  develops  violent  dysentery. 

Other  calves,  born  apparently  well,  proceed  to  break  down 
with  diarrhea  in  a  few  hours  to  eight,  ten  or  more  days. 
The  later  in  life  the  attack,  the  less  stormy  its  course.  When 
violent  dysentery  is  impending,  the  first  indication  of  tho 
coming  storm  is  a  sudden  rise  in  temperature.  At  this  epoch 
the  calf  is  not  notably  ill,  the  feces  are  not  thin,  and  there  is 
no  marked  loss  of  appetite.     But  this  in  severe  cases  is  not 


Co7igenital  Infections  of  Calves  659 

for  long.  Soon  in  many  cases  there  are  streaks  of  blood  in 
the  feces,  if  any  chance  to  be  voided.  In  one  to  a  few  hours 
later  the  storm  breaks  and  the  observer  frequently  sees  one 
of  the  most  virulent  and  rapidly  fatal  diseases  in  animals, 
often  destroying  life  in  ten  or  twelve  hours.  When  dysen- 
tery sets  in,  the  temperature  vacillates.  Often  the  anus  is 
paretic,  the  rectum  is  open  and  flaccid,  and  the  thermometer 
reveals  little  of  the  actual  temperature  of  the  body. 

The  feces  offer  the  widest  possible  variation  in  character. 
In  the  fetus,  the  diarrheic  feces  are  usually  yellowish,  green- 
ish-black or  black.  In  post-natal  dysentery  the  fecal  dis- 
charges are  much  the  same  as  in  the  intra-uterine  diarrhea, 
if  the  storm  breaks  before  the  calf  has  taken  milk,  or  until 
the  milk  or  its  derivatives  have  passed  through  the  digestive 
tract  to  modify  the  excrement.  After  milk  has  been  taken, 
the  character  of  the  excrement  is  necessarily  altered.  The 
milk-filled  stomach  serves  as  a  large  flask  filled  with  an 
excellent  medium  for  the  multiplication  of  the  bacteria  pres- 
ent, while  the  body  heat  provides  an  ideal  incubative 
warmth.  The  milk  undergoes  rapid  bacterial  decomposition 
and  is  hurried  along  the  alimentary  tract  with  great  rapid- 
ity. The  feces  may  contain  some  small  decomposing  milk 
particles  still  retaining  some  of  its  white  color,  but  it  has 
mostly  disappeared.  The  bacteria  cause  the  liberal  forma- 
tion of  highly  fetid  gases,  which,  mixed  in  small  bubbles  in 
the  thin  feces  may  lend  to  it  a  whitish  color.  The  color 
varies  greatly,  however.  Sometimes  it  is  greenish,  often 
brownish  or  yellow.  In  very  severe  cases  the  discharges 
are  extremely  thin  and  watery,  mixed  with  minute  particles 
of  debris,  giving  it  a  dirty  brown  color,  and  charged  v/ith 
bubbles  of  highly  fetid  gas  which  escape  quickly.  In  large 
stables  where  numerous  calves  are  suffering  from  the  dis- 
ease in  various  stages,  the  odor  from  the  calves  is  highly 
repulsive,  of  a  sweetish  sickening  character. 

The  general  appearance  of  the  calf  changes  rapidly.  The 
watery  feces  are  forcibly  expelled  for  a  time,  but  later  es- 
cape involuntarily  through  the  paretic  anal  sphincter.  The 
calf  loses  weight  and  volume  with  enormous  rapidity.     It 


66o  Diseases  of  the  Genital  Organs 

takes  no  food  or  water,  while  the  water  of  the  tissues  is 
being  rapidly  withdrawn  to  constitute  the  chief  volume  of 
the  diarrheic  discharges.  The  calf  becomes  unable  to  rise, 
lies  flat  on  its  side  with  its  head  drawn  back  (opisthotonus), 
becomes  unconscious  and  dies. 

Short  of  this  violent  type  there  is  every  gradation.  In 
cases  of  great  virulence,  the  dysentery  may  at  any  time 
abate,  the  calf  rally,  without  definite  therapeutic  handling 
undergo  more  or  less  marked  improvement,  and  may  per- 
haps eventually  recover. 

Regardless  of  the  grade  of  alimentary  disturbance,  there 
is  a  tendency  toward  the  development  of  pneumonia.  Some- 
times the  pneumonia  develops  suddenly  and  violently  with 
all  the  clinical  symptoms  of  that  affection.  Other  cases 
creep  on  insidiously  with  a  hacking  cough  associated  with 
digestive  disturbances.  The  pulmonary  complications  ag- 
gravate the  digestive  disturbances  by  lowering  still  more 
the  resisting  powers  of  the  animal.  In  many  animals  the 
only  evidence  of  pulmonary  disease  is  a  persistent  hacking 
cough. 

The  clinical  evidences  of  pneumonia  may  appear  at  any 
time  from  shortly  after  birth  up  to  ninety  or  one  hundred 
days.  Like  the  dysentery,  it  is  more  prone  to  pursue  a 
stormy  course  when  it  develops  early.  Dysentery  and  pneu- 
monia each  tend  to  conceal  and  to  aggravate  the  other.  The 
high  temperature  of  dysentery  causes  rapid  breathing,  sim- 
ulating pneumonia,  and  the  dyspnea  of  pneumonia  tends  to 
detract  attention  from  any  dysentery  present. 

Arthritis  as  a  concurrent  lesion  is  not  rare,  and,  like 
pneumonia,  may  be  violent  or  may  be  of  so  low  a  degree  as 
to  be  difficult  of  clinical  recognition.  The  onset  of  pyemic 
arthritis  may  be  extremely  sudden.  The  calf  is  up  and 
about,  feeding  and  appearing  well.  An  hour  later  it  may  be 
so  lame  in  one  limb  that  it  refuses,  or  is  unable  to  bear 
weight  upon  the  affected  limb.  The  involved  joint  is  greatly 
swollen,  tense,  hot,  and  extremely  painful  when  manipulated. 
A  little  later  some  other  joint  may  be  equally  involved. 
When  two  or  more  limbs  become  affected,  the  calf  is  un- 


Congejiital  Infections  of  Calves  66 1 

willing  or  unable  to  stand.  In  other  cases  the  affected  joints 
are  neither  greatly  swollen  nor  very  painful.  Several  or  all 
limbs  may  be  involved,  causing  the  calf  to  walk  slowly  and 
cautiously  without  marked  lameness  in  any  one  limb.  As 
in  pneumonia,  so  in  arthritis,  lesions  are  found  upon  au- 
topsy which  had  not  been  clinically  recognizable. 

Pyemic  abscesses,  which  occur  somewhat  rarely  in  all  or- 
gans and  tissues  of  the  body,  have  the  same  significance  as 
arthritis.  Occasionally  a  pyemic  abscess  occurs  in  the 
spinal  canal,  causing  a  gradual  and  finally  complete  paraly- 
sis. In  other  instances  the  pyemic  abscess  is  inter-articular 
in  the  spinal  column  and  eventually  breaks  into  the  spinal 
canal,  inducing  sudden  and  complete  paralysis  suggesting 
fracture  of  the  spinal  column.  Other  evidences  of  disease 
appear  which  are  not  readily  assignable  to  a  logical  place  in 
the  course  of  the  basic  infection.  Prominent  among  these 
are  ulcers  and  abscesses  in  the  lips  and  cheeks.  These  ag- 
gravate exceedingly  the  basic  malady.  The  lesions  are  ap- 
parently due' to  a  secondary  invader  (B.  necrophorus?)  for 
which  the  basic  infection  has  prepared  a  vulnerable  field. 
Rachitic-like  enlargements  of  the  bones  are  not  rare,  but 
their  exact  relation  to  the  basic  invasion  is  not  understood. 

When  a  degree  of  dysentery,  pneumonia  or  arthritis  is 
present  which  clearly  imperils  the  life  of  the  patient,  the 
presence  of  disease  is  not  disputed,  but  the  results  of  vary- 
ing degrees  of  infection  in  new-born  calves  offer  such  in- 
finite gradations  that  it  is  impossible  for  a  majority  of  ob- 
servers to  agree  upon  a  clear  line  of  demarcation  between 
health  and  disease.  So  far  as  known,  the  bacteria  which 
cause  dysentery,  pneumonia,  septicemia,  and  pyemia  in 
young  calves  exist  in  the  bodies  of  essentially  all  cattle,  and 
disease  or  health  is  determined,  not  by  the  presence  or  ab- 
sence of  given  bacteria,  but  by  the  ratio  of  bacterial  force 
to  the  resistance  of  the  patient.  A  healthy  new-born  calf 
has  lustrous  hair,  its  body  is  plump  and  graceful,  its  eye 
bright,  its  spirits  gay,  and  its  body  functions  are  promptly 
and  evenly  performed.  The  bowels  promptly  expel  the  me- 
conium, which,  as  it  escapes  from  the  anus,  does  not  adhere 


662  Diseases  of  the  Genital  Organs 

to  the  tail  or  surrounding  parts.  The  tufts  of  hair  about  the 
sheath  opening  (preputial  tuft)  and  the  vulva  (vulvar  tuft) 
over  which  the  urine  flows  are  not  stained,  matted  or  dirty. 
Experimentally  this  state  can  be  maintained  for  several 
months,  if  not  indefinitely.  Naturally,  in  range  cattle  of 
high  reproductive  efficiency,  the  status  at  birth  tends  to  be 
continued  over  a  long  period  of  time.  In  dairy  herds  and 
in  purebred  beef  herds,  w^hich  closely  approach  dairy  herds 
in  general  plans  of  handling,  the  calf  may  soon  break  down 
with  dysentery,  pneumonia,  joint-ill,  or  other  manifestations 
of  serious  or  critical  disease,  or  show  within  five  to  ten 
days  notable  deviation  from  the  ideal. 

The  temperature  becomes  elevated.  This  is  so  nearly  uni- 
versal that  writers  commonly  hold  that  the  temperature  of 
a  young  calf  is  higher  than  that  of  an  adult.  The  experi- 
ments in  my  department  indicate  that  this  belief  is  a  fallacy 
and  that  the  higher  temperature  of  young  calves  is  patho- 
logical. The  hair  soon  loses  its  lustre  and  becomes  dry, 
rough  and  faded.  The  skin  becomes  dirty.  There  are  di- 
gestive disturbances  of  great  variety.  Almost  always  the 
feces  are  adhesive  and  stick  to  tail  and  buttocks.  They  are 
soft,  medium,  or  hard,  but  the  adhesiveness  persists  in  each 
type.  The  consistency  and  color  vary  from  day  to  day.  Usu- 
ally they  are  fetid  and  expelled  frequently  in  small  amounts. 
The  total  volume  of  feces  is  greater  than  in  health,  but  the 
volume  voided  at  one  time  is  much  less.  The  feces  are  irri- 
tant and  frequently  cause  the  matted  hairs  to  fall  out,  leav- 
ing hairless  areas  on  the  tail  or  buttocks. 

The  calf  may  be  either  gaunt  or  pot-bellied.  Its  appetite 
is  capricious,  and  it  may  swallow  straw,  shavings  or  other 
indigestible  matter.  Its  growth  is  slow  and  uncertain. 
While  a  typically  healthy  calf  well  fed  should  gain  not  less 
than  two  per  cent,  of  its  body  weight  per  day,  the  unthrifty 
one  drops  below  this  standard.  There  is  a  hacking  cough. 
The  calf  plays  but  little,  in  marked  contrast  with  the  typi- 
cally healthy  calf  which  is  one  of  the  gayest  rompers  among 
domestic  animals.  The  preputial  or  vulvar  tuft  of  hairs  be- 
comes stained  a  deep  brown  and  then  black,  to  remain  so 


Co?ige7iital  bifedions  of  Calves  663 

for  life.  The  hairs  become  matted  together  in  hard  masses. 

These  evident  deviations  from  typical  health  can  not  be 
classed  as  dysentery,  pneumonia,  septicemia,  or  arthritis, 
but  are  due,  so  far  as  can  now  be  determined,  to  the  same 
infections.  The  results  differ  because  the  ratio  of  bacterial 
force  to  the  resistance  of  the  patient  differs.  Such  calves 
finally  recover  a  physiologic  appearance  at  one  hundred  and 
twenty  to  one  hundred  and  eighty  days,  when  they  shift 
more  or  less  completely  from  a  milk  to  a  vegetable  diet. 
The  pot-belly  or  gauntness  slowly  abates,  the  feces  cease  to 
adhere  to  the  tail  and  buttocks,  the  harsh  dry  coat  regains 
its  lustre,  the  masses  of  epidermal  debris  in  the  hair  disap- 
pear, the  animal  becomes  vigorous  and  grows  rapidly.  It 
then  enters  upon  a  period  of  unusual  good  health,  which  ex- 
tends to  puberty,  and  breeding  occurs.  The  only  trace  of 
the  adversity  through  which  it  has  passed  is  the  matting  and 
staining  of  the  vulvar  or  preputial  tuft  and  the  persistence 
of  more  or  less  numerous  nodular  elevations  in  the  vulvar 
or  preputial  mucosa,  known  as  the  nodular  venereal  dis- 
ease. The  significance  of  the  matting  of  the  hairs  and  of  the 
lesions  in  the  mucosa  is  not  accurately  known.  I  do  not  be- 
lieve that  during  this  epoch  of  apparent  good  health  the  ani- 
mal has  become  free  from  the  infection.  Instead  I  believe 
that  here  and  there  the  infection  still  lingers,  but  there  has 
arisen  an  important  power  of  resistance  to  the  bacteria 
which  holds  them  in  abeyance  and  renders  them  essentially 
saprophytic  for  the  time  being. 

The  post-mortem  findings  vary  with  the  form  and 
duration  of  the  disease.  In  calves  which  succumb  to 
violent  dysentery,  the  lesions  are  those  of  gastro-enteri- 
tis  and  septicemia.  Hemorrhages  occur  in  the  capsule 
of  the  spleen  or  the  outer  and  inner  walls  of  the  heart 
beneath  the  pleura  (See  Fig.  205)  and  elsewhere.  The 
fourth  stomach  shows  great  reddening  (congestion)  of  its 
mucosa  and  the  folds  are  generally  edematous.  The  duode- 
num shows  similar  lesions.  The  remainder  of  the  alimen- 
tary tract  is  not  so  markedly  altered,  as  a  rule,  although 
frequently  the  summits  of  the  rectal  folds  are  intensely  con- 
gested and  sometimes  hemorrhagic. 


664 


Diseases  of  the  Genital  Organs 


Fig.  2(^5— Costal  Pleura  of  Abort  at  Full  Term,  showing  the  Petechiae 

and  Hemorrhag-es  Commonly  seen  in  Abortion,  Calf 

Sepsis,  and  Dysentery. 


Fic.  2u6— Pyaemic  Abscess  in  Spinal  Canal  of  Calf. 

•Sd",  Spinal  ronl  ;    .  /,  ..l)si\ss. 


Congenital  hifections  of  Calves  665 

When  the  immediate  cause  of  death  has  been  pneumonia, 
the  principal  lesions  are  naturally  found  in  the  lungs.  In 
most  cases  only  the  anterior  lobes  are  involved,  but  some- 
times even  the  diaphragmatic  lobe  is  largely  solidified.  The 
pneumonic  areas  are  whitish  or  grayish-white,  mottled,  and 
feel  much  like  the  normal  pancreas.  Pleuritis  is  seldom 
seen.  Microscopically  the  affected  area  is  filled  with  enor- 
mous numbers  of  polymorphonuclear  leucocytes,  which  give 
to  the  lung  its  grayish,  mottled  appearance.  The  condition 
is  one  of  severe  purulent  broncho-pneumonia.  In  the  milder 
cases,  associated  with  hacking  cough,  there  are  few  to  many 
small  circumscribed  pneumonic  areas,  from  the  size  of  a 
pinhead  to  that  of  a  pea.  The  synovial  membranes  of  the 
femoro-tibio-patellar,  tarsal  and  carpal  joints  may  be  in- 
flamed. The  pyemic  abscesses  usually  have  weak,  atonic 
walls.  The  predominant  organism  encountered  is  of  the 
colon  group  and  offers  nothing  remarkable  in  cultures  or  by 
staining. 

The  period  and  avenues  of  invasion  of  the  calf  need 
to  be  comprehended  before  intelligent  control  is  possi- 
ble. It  has  now  been  made  perfectly  clear  that  calf  septi- 
cemia, dysentery,  arthritis,  pneumonia,  and  the  other  phe- 
nomena grading  off  imperceptibly  from  these  to  ideal  health, 
are  due  fundamentally  to  an  intra-uterine  infection  not  sep- 
arable from  the  infections  causing  abortion  and  fetal  diar- 
rhea. This  has  already  been  discussed.  It  is  equally  clear 
that  post-natal  infection  occurs,  chiefly  through  the  mouth 
in  contaminated  food.  Probably  some  cases  are  due  to  navel 
infection. 

The  handling  of  calf  sepsis,  dysentery,  pneumonia,  arth- 
ritis, and  those  types  of  infection  shading  off  gradually  to 
health  and  not  definitely  perilous  to  life,  has  a  dual  meaning 
in  animal  husbandry  which  should  be  fully  comprehended. 
There  are  two  widely  different  conceptions  of  curing  a  dis- 
ease, or  some  phenomenon  called  disease.  The  common 
meaning  of  cure  is  the  rescue  of  the  patient  from  death.  In 
such  infections  as  those  now  under  consideration,  especially 
when  dealing  with  purebred  calves  designed  for  breeding 


666  Diseases  of  the  Genital  Organs 

purposes,  the  saving  of  the  life  of  a  calf  is  an  utterly  worth- 
less performance  unless  there  be  added  the  safeguarding  of 
sexual  health.  Few  if  any  principles  regarding  the  infec- 
tions of  the  genital  organs  of  cattle  are  clearer  today  than 
that  the  fertility  of  a  bull  or  heifer,  when  arrived  at  breed- 
ing age,  has  been  fixed  unalterably  during  its  nursing  period. 
The  most  important  result  to  be  sought  in  the  rearing  of 
calves  is  not  the  conservation  of  their  lives,  but  the  control 
of  infection  which  constantly  tends  to  attain  a  habitat  in  the 
genital  system  of  both  sexes,  where  it  persists  until  breed- 
ing age,  when  it  may  prevent  reproduction  or,  infinitely 
worse,  may  prove  a  serious  menace  to  other  animals  with 
which  the  infected  animal  comes  into  sexual  relations.  This 
danger  is  disputed  by  many  and  ignored  by  nearly  all  breed- 
ers and  veterinarians,  but  the  evidence  which  has  been  ac- 
cumulated is  so  strong  that  it  is  at  least  time  to  give  to  the 
subject  thoughtful  attention.  It  is  common  knowledge  that 
in  large  herds  where  sterility,  abortion,  metritis,  retained 
fetal  membranes,  and  other  phenomena  of  this  group  are 
violent,  the  calves  suffer  much  from  dysentery  and  pneu- 
monia. When  heifers  in  these  herds  reach  breeding  age,  it 
is  notorious  that  upon  the  average  it  requires  more  than 
twice  the  number  of  copulations  to  produce  pregnancy  than 
is  necessary  in  adult  cows.  Once  pregnant,  heifers  which 
have  been  unhealthy  as  calves  abort  in  a  ratio  two  to  three 
times  as  high  as  observed  in  cows.  On  the  other  hand,  in 
small  grade  herds  where  often  sterility  and  abortion  are 
rare  and  the  calves  are  healthy,  the  heifers  upon  reaching 
breeding  age  conceive  as  promptly  as  cows  and  carry  their 
calves  as  safely.  There  are  also  reliable  statistical  data  sup- 
porting this  position,  an  example  of  which  is  shown  in  the 
chart  designated  Fig.  207.  The  herd  was  a  large  one,  the 
records  are  unusually  complete  and  accurate,  the  duration  of 
time  covered  by  the  data  is  extensive,  and  the  difference  in 
the  behavior  of  the  two  groups  of  heifers  is  distinct  and  re- 
markable. They  were  kept  in  the  same  stables  and  pastures, 
were  bred  to  essentially  the  same  bulls,  were  the  progeny  of 
the  same  group  of  cows  as  nearly  as  possible,  and  were  in 


Co7igenital  Infections  of  Calves 


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668  Diseases  of  the  Genital  Organs 

every  way  handled  alike  except  that  the  second  group  was 
more  carefully  handled  and  was  healthier  during  the  nur- 
sery period.  Everywhere  that  I  have  been  able  to  observe, 
this  view  is  supported  by  clinical  facts.  It  is  a  principle 
which  has  an  application  in  other  species,  and  parallel  evi- 
dence is  submitted  in  connection  with  the  disease  interfer- 
ing with  reproduction  in  swine.  Consequently  I  hold  that, 
in  handling  the  congenital  infections  of  calves,  the  conser- 
vation of  life  should  not  be  regarded  as  an  end  in  itself,  but 
merely  as  an  essential  pre-requisite  to  guarding  the  sexual 
health  and  vigor  of  the  future  adult. 

The  handling  of  dysentery  must  be  founded  upon  certain 
well  established  basic  facts.  Since  the  infections  under  dis- 
cussion are  primarily  intra-uterine,  intelligent  endeavor 
should  be  made  to  prevent  or  to  minimize  such  invasion. 
This  is  to  be  accomplished  by  securing,  as  far  as  possible, 
the  mating  of  sexually  sound  animals  by  such  means  as  have 
already  been  advised  in  the  preceding  pages.  If  conception 
occurs  in  a  clean  uterus,  as  the  result  of  coitus  with  a  sexu- 
ally sound  bull,  the  calf  will  be  born  without  serious  infec- 
tion in  its  alimentary  tract.  If  the  uterus  or  cervix  is  badly 
infected  prior  to  conception,  or  if  the  bull  is  suffering  from 
serious  genital  infection,  which  is  ejaculated  with  the  semen, 
the  calf  when  born  will  be  critically  infected.  During  preg- 
nancy no  remedy  now  known  can  ameliorate  the  infection. 
No  known  substance  administered  in  any  manner  has  been 
shown  to  invade  the  utero-chorionic  cavity  and  disinfect  it, 
or  to  pass  through  the  placental  filter  and  destroy  bacteria 
in  the  fetal  alimentary  tract  or  other  organ.  Vendors  of 
biologies  have  offered  alleged  cures  or  preventatives  to  be 
given  pregnant  cows,  but  I  know  of  no  ground  for  asserting 
that  they  have  value. 

Although  the  precautions  advised  in  the  preceding  para- 
graph are  of  great  value  and  are  to  be  urgently  recom- 
mended, they  are  imperfect.  Generally  no  thought  is  gi\(>n 
to  such  care  until  the  storm  breaks.  Many  of  the  cows  are 
pregnant  and  the  fetuses  critically  infected,  and  the  termina- 
tion of  pregnancy  must  be  awaited  before  the  infection  in 


Congenital  Infections  of  Calves  669 

the  calf  (as  in  the  cow)  can  be  attacked  directly.  In  prin- 
ciple each  calf  at  the  time  of  its  birth  should  be  regarded  as 
possibly  carrying  bacteria  included  in  its  meconium  which 
constitute  a  peril  to  its  life  and  health.  This  peril  is  largely 
avoidable  and  should  be  anticipated.  The  chief  obstacle  to 
the  adoption  of  measures  to  forestall  the  development  of  the 
included  bacteria  into  an  active  and  perilous  infection  is  the 
apparently  good  or  perfect  health  of  the  calf.  To  the  lay- 
man and  to  many  veterinarians  it  appears  imprudent  to 
undertake  the  handling  of  an  apparently  healthy  calf  to  pre- 
vent serious  or  mortal  illness  from  included  bacteria  which 
reveal  no  signs  of  their  presence.  There  are  at  present  no 
known  means  which  can  be  practically  applied  by  which  the 
breeder  or  veterinarian  can  distinguish  between  the  new- 
born calf  which  does,  and  that  which  does  not  carry  in  its 
digestive  tract  dangerous  bacteria.  Choice  must  therefore 
be  made  between  two  opposing  policies :  the  assumption  that 
the  calf  carries  dangerous  bacteria  in  its  gastro-intestinal 
tract,  the  development  of  which  shall  be  forestalled,  and  the 
contrary  assumption  that  the  apparently  healthy  calf  does 
not  carry  dangerous  bacteria,  with  the  postponement  of  ac- 
tion until  after  the  storm  breaks.  I  favor  emphatically  the 
first  assumption.  The  veterinarian  is  concerned  chiefly  with 
purebred  or  high  grade  calves,  because  these  constitute  the 
basis  of  the  best  herds  and  the  source  of  supply  for  breed- 
ing stock  in  the  improvement  of  common  cattle.  The  pure- 
bred calves  are  the  most  intensely  infected  and  should  be 
most  vigorously  handled. 

Ordinarily  the  calves  of  dairy  cows  are  fed  by  hand  either 
from  birth  or  after  a  very  few  days.  I  favor  taking  the 
calf  immediately  from  the  cow  without  permitting  the  dam 
to  lick  it.  By  this  method  there  is  a  total  absence  of  worry 
over  the  parting  by  either  mother  or  young,  the  calf  is  more 
readily  taught  to  feed,  and  the  amount  of  food  and  intervals 
between  feedings  are  under  control  at  the  most  crtical  time. 
The  calf  should  be  removed  to  an  isolated,  clean,  comforta- 
ble stall,  and  rubbed  dry.  Post-natal  infection  through  the 
umbilic  wound  should  be  guarded  against  by  permitting  the 


670  Diseases  of  the  Genital  Orga?is 

navel  cord  to  be  ruptured  by  the  natural  method  of  over- 
stretching, by  which  it  parts  regularly  at  two  to  four  inches 
from  the  umbilicus.  When  permitted  to  rupture  in  this 
manner,  the  elastic  stumps  of  the  umbilic  arteries,  dragging 
with  them  the  stump  of  the  urachus,  recoil  into  the  abdomi- 
nal cavity  and  come  to  rest  two  or  more  inches  above  and 
posterior  to  the  umbilicus.  This  leaves  only  the  vein  and  the 
the  amniotic  covering  of  the  cord  to  consider.  The  blood  in 
the  umbilic  vein  drops  out  promptly  and  the  vein  collapses 
at  once.  No  tying  of  the  umbilic  stump  should  be  attempted, 
as  this  interferes  with  the  escape  of  blood  from  the  umbilic 
vein.  The  layman  should  understand  that  there  is  no  bleed- 
ing, in  the  true  sense,  from  the  umbilicus  of  a  normal  calf. 
The  arteries  when  broken  recoil  in  a  manner  rendering  the 
escape  of  blood  impossible.  Since,  if  the  umbilic  stump  is 
ligated  after  having  broken  naturally,  the  arteries  are  not 
included  in  the  ligature,  ligation  could  not  prevent  arterial 
bleeding  if  it  were  threatened.  A  ligature  can  serve  only  to 
retain  within  the  navel  veins  that  blood  which  inevitably 
dies  and  should  escape.  If  the  heart  valves  are  defective, 
there  may  be  hemorrhage  from  the  navel  veins,  but  in  that 
case  the  death  of  the  young  animal  is  an  economic  gain.  The 
stump  of  the  navel  cord  should  be  disinfected  by  some  re- 
liable plan.  I  prefer  a  solution  of  1-1000  corrosive  subli- 
mate. A  goblet,  cup  or  large-mouthed  bottle  is  filled  with 
this  solution,  then  pressed  against  the  abdominal  floor,  sur- 
rounding the  umbilicus,  thus  completely  immersing  the  navel 
stump,  and  held  there  for  ten  to  fifteen  minutes.  This  may 
be  repeated  in  twelve  to  twenty-four  hours  if  the  navel 
stump  has  not  dried  up.  As  much  of  the  bacteria-containing 
meconium  as  practicable  should  be  removed  promptly  from 
the  rectum  and  large  intestines.  So  far  as  I  have  observed, 
the  best  plan  is  the  use  of  a  warm  enema  of  physiologic  salt 
solution  (1  ounce  salt  to  1  gallon  water).  It  is  adminis- 
tered with  a  hospital  irrigator  to  which  is  attached  a  small 
soft  rubber  horse  catheter.  The  irrigator  is  held  slightly 
above  the  calf  and  the  catheter  gently  introduced  into  the 
rectum  while  the  enema  is  slowly  flowing  in.    The  catheter 


Co  ngen  ita  I  hifedio  ns  of  Ca  Ives  671 

should  be  introduced  ten  to  twenty  inches.  If  a  suitable 
vessel  is  held  beneath  the  anus,  the  meconium,  as  it  is  ex- 
pelled with  the  enema,  may  be  caught  and  the  bedding  not 
contaminated.  It  is  well  to  repeat  the  enema  twice  daily 
for  two  days  at  least. 

In  all  herds  where  infections  of  calves  are  common,  and 
in  those  calves  in  comparatively  healthy  herds  in  which  the 
dam  has  retained  fetal  membranes  or  other  type  of  metritis, 
calf  scours  serum  should  be  administered  liberally  as  soon  as 
the  calf  is  born.  I  believe  it  would  be  even  better  in  pure- 
bred calves  of  high  value  to  make  the  administration  of  calf 
scours  serum  a  universal  rule.  According  to  observation, 
depending  upon  the  probable  degree  of  infection  present,  it 
is  well  to  give  at  the  time  of  birth  20  to  40  mils  of  the  serum, 
and  if  the  calf  appears  well  and  the  temperature  remains 
below  102  degrees  F.,  to  give  10  to  20  mils  each  twelve  hours 
until  four  doses  have  been  given.  Clinical  observations  ap- 
pear to  indicate  that  such  handling  not  only  prevents  in  a 
large  measure  the  development  of  dysentery,  pneumonia, 
and  arthritis,  but  also  invigorates  the  calf,  guards  it  against 
less  evident  types  of  the  same  infections,  and  is  an  impor- 
tant element  in  laying  a  secure  foundation  for  sexual  sound- 
ness when  the  calf  reaches  breeding  age. 

Food  should  be  completely  withheld  until  the  calf  is  twen- 
ty-four hours  old,  because  during  this  interval  most  of  the 
bacteria  present  in  the  alimentary  tract  may  be  removed  by 
the  enemas  and  the  calf  may  acquire  some  degree  of  resist- 
ance to  the  bacteria  remaining.  There  is  an  old  fallacy  that 
a  calf  needs  a  feed  of  milk  immediately  after  birth,  and 
most  writers  on  animal  husbandry  and  veterinary  obstetrics 
so  advise,  but  it  should  be  clearly  understood  that,  up  to  the 
moment  of  the  severance  of  the  navel  cord,  the  young  ani- 
mal has  been  richly  fed  and  its  blood  is  well  charged  with 
reserve  nutritive  material  ample  for  twenty-four  hours  and 
enough  to  sustain  life  for  several  days.  A  healthy  calf  from 
an  equally  healthy  mother  is  not  born  in  a  starving  condi- 
tion, nor  even  hungry.  It  is  quite  true  that  it  knows  no 
better  than  to  eat  and  if  given  an  opportunity,  will  almost 


672  Diseases  0/  the  Genital  Organs 

invariably  gorge  itself  with  food  of  which  it  needs  no  part. 
If  one  will  take  the  trouble  to  watch  a  calf  taken  from  its 
dam  and  kept  twenty-four  hours  without  food,  no  evidence 
of  hunger  will  be  manifested  during  that  period. 

If  it  could  be  known  that  a  calf  carried  no  potentially 
harmful  bacteria  in  its  gastro-intestinal  tract,  an  immediate 
feed  of  milk  might  not  do  harm.  It  certainly  can  do  no  good. 
But  most  calves  are  not  thus  free  from  bacteria,  for  the 
growth  of  which  milk  constitutes  an  ideal  medium.  When  a 
calf  of  average  health  is  born  in  an  ordinary  dairy  herd,  its 
rectal  temperature  is  below  102  degrees  F.,  and  generally 
it  will  remain  there  so  long  as  the  calf  is  not  fed.  If  given 
a  feed  of  milk,  its  temperature  rises  (bacterial  decomposi- 
tion of  milk  with  absorption  of  bacterial  poisons  by  the 
calf)  within  two  to  four  hours,  and  the  amount  of  elevation 
will  be  proportionate  to  the  volume  of  milk  fed.  The  bac- 
terial decomposition  of  milk  in  the  alimentary  tract  of  nurs- 
lings is  so  nearly  universal  that  it  has  led  to  the  fallacious 
teaching  that  the  physiologic  temperature  of  the  new-born 
is  higher  than  that  of  the  adult.  The  temperature  is  indeed 
usually  higher  in  the  new-born,  but  it  is  pathologic,  not 
physiologic,  as  the  experimental  feeding  of  calves  has  clearly 
and  emphatically  shown.  Since  it  is  unnecessary  to  feed  the 
calf  during  its  first  twenty-four  hours,  and  such  feeding  is 
accompanied  by  danger,  this  period  should  be  looked  upon 
as  one  in  which  to  do  the  utmost  to  forestall  the  active 
arousal  of  infection  and  to  prepare  the  calf  by  every  avail- 
able means  known  for  feeding  safely  and  successfully.  The 
temperature  of  the  calf  should  be  measured  two  or,  better, 
three  times  daily  during  the  first  ten  days,  since  an  eleva- 
tion of  temperature  is  the  most  constant  and  valuable  sign 
of  approaching  trouble.  It  is  especially  important  that 
the  temperature  of  the  calf  be  measured  just  before 
feeding  so  that  if  fever  is  present  the  milk  may  be  with- 
held. The  feces  are  also  to  be  watched  closely  with 
reference  to  consistency,  color,  odor,  and  the  presence 
or  absence  of  blood.  In  most  cases  of  impending 
dysentery  blood  may  be  seen  in  the  feces.     At  the  end  of 


Congenital  Infections  of  Calves  673 

twenty-four  hours  the  calf  should  be  fed  about  two  per  cent, 
of  its  body  weight  of  milk-:  that  is,  if  a  calf  weighs  fifty 
pounds  at  birth,  it  should  be  fed  at  first  one  pound  of  milk 
morning  and  night.  This  ration  should  be  continued  for  a 
period  of  four  or  five  days,  during  which  time  the  calf  will 
lose  weight  but  will  retain  its  vigor  and  the  lustre  of  its  hair. 
At  the  expiration  of  this  period,  the  ration  should  be  slowly 
and  carefully  increased  by  four  to  eight  ounces  per  feed  until 
a  satisfactory  ration  is  attained.  The  best  source  from 
which  to  obtain  milk  is  from  its  dam.  At  one  time  I  was  led 
to  believe  that  the  milk  should  be  taken  from  a  healthy  cow, 
even  if  the  rule  excluded  that  of  the  dam,  but  more  recent 
investigations  appear  to  contradict  this  view.  The  age-old 
belief,  that  the  dam's  milk  is  better  for  a  young  animal  than 
the  milk  of  another  animal  of  the  same  or  other  species,  ap- 
pears to  be  supported  by  important  scientific  facts.  I  have 
stated  that  the  pregnant  uterus  generally  contains  potential- 
ly pathogenic  bacteria,  and  that  the  fetal  alimentary  tract 
usually  contains  bacteria  identical  with  those  in  the  uterus. 
The  blood  of  the  cow,  as  shown  by  agglutination  tests,  con- 
tains protective  substances  (antibodies)  against  the  bacteria 
in  her  uterus.  These  substances  do  not  pass  the  placental 
filter  or  otherwise  enter  the  fetal  circulation.  The  bacteria 
included  in  the  meconium  generally  cause  no  active  infection 
in  the  fetus,  and  no  antibodies  are  formed  in  its  blood. 
Hence  the  fetus  is  commonly  born  without  any  acquired  re- 
sistance to  the  bacteria  in  its  alimentary  tract.  The  milk 
of  the  mother  seems,  however,  to  contain  such  antibodies, 
so  that  a  calf  in  feeding  upon  its  dam's  milk  is  taking  with 
it  substances  equivalent  to  calf  scours  serum.  There  is 
something  in  the  milk  of  the  mother  which  tends  to  repress 
the  gastro-intestinal  bacteria  of  the  calf.  The  milk  should 
be  drawn  carefully  under  the  best  rules  of  cleanliness  in  a 
sterilized  pail.  Special  care  should  be  taken,  in  cases  of  re- 
tained fetal  membranes  or  other  types  of  genital  discharge, 
to  wash  and  disinfect  the  udder  prior  to  drawing  milk  for 
the  calf. 

43 


674  "  Diseases  of  the  Genital  Organs 

No  harm  will  ordinarily  come  to  the  cow  if  left  without 
milking  for  twenty-four  hours  after  calving,  when,  under 
the  plan  advised,  the  calf  will  get  colostrum  in  its  first  feed. 
Notwithstanding  the  assertions  of  numerous  teachers  re- 
garding feeding,  the  necessity  for  feeding  colostrum  to  a 
calf  is  a  myth.     Experimentally  I  have  fed  many  calves  upon 
boiled  milk  from  birth,  and  colostrum  cannot  be  boiled  with- 
out coagulating.     While  a  calf  can  be  well  grown  experi- 
mentally upon  boiled  milk  from  the  outset,  it  requires  very 
close  watching  and  skillful  handling  in  most  instances.     I 
prefer  that  for  the  first  eight  or  ten  days  the  calf  should  be 
fed  the  very  small  ration  mentioned  of  raw  milk  from  its 
dam.     During  this  period  there  is  confessedly  the  danger 
from  infection  borne  in  her  milk,  but  under  usual  condi- 
tions this  is  more  than  counterbalanced  by  its  content  of 
protective  substances  of  a  highly  essential  character.    The 
plan  has  very  important  limitations.     If  the  dam  is  tuber- 
cular, her  raw  milk  should  not  be  fed  to  her  calf.     Either 
the  milk  of  a  tubercle-free  cow  should  be  substituted  or  the 
milk  of  the  dam  boiled,  fed  very  sparingly,  and  the  loss  of  the 
antibodies  in  her  milk  destroyed  by  boiling,  counterbalanced 
by  the  liberal  use  of  calf  scours  serum.     Similar  limitations 
apply  to  diseases  of  the  udder.     Perhaps  the  greatest  ob- 
stacle to  overcome  in  guarding  the  health  of  young  calves  is 
the  deeply  rooted  prejudice  of  breeders  that  heavy  feeding 
from  the  first  is  essential  and  that,  at  whatever  cost,  the 
calf  ynuiit  grow.     Instead  I  have  emphasized  securing  first  a 
healthy  body,  knowing  that  in  the  end  the  healthy  calf  makes 
the  greatest  and  best  growth.    The  rule  appears  to  be  that 
with  a  moderate  number  of  bacteria  in  the  gastro-intestinal 
tract,  a  small  volume  of  milk  may  be  digested  and  assimilated 
with  a  minimum  febrile  disturbance,  but,  when  the  volume 
of  milk  is  greater,  the  febrile  reaction  is  stronger.     Diges- 
tion may  be  regarded  as  a  triumph  of  the  digestive  ferments 
over  the  bacteria  present,  by  which  they  convert  food  eaten 
into  products  which  may  be  absorbed  and  used  by  the  body 
for  its  maintenance  and  growth,     it'  Ihc  bacteria  present 
prevail  over  the  digestive  ferments,  proihicts  are  formed  and 


Congenital  Infections  of  Calves  .  675 

absorbed  which  are  toxic  for  the  body 'and  imperil  health 
and  life.  Presumably  there  is  no  material  difference  in  the 
amount  of  digestive  ferments  poured  out  in  response  to  the 
presence  of  a  small  or  a  large  volume  of  food.  Consequently 
it  should  be  expected  that,  within  reasonable  limits,  the 
smaller  the  amount  of  milk  fed,  the  greater  the  ratio  of 
digestive  ferments  to  the  volume  of  milk,  and  hence  the 
prompter  and  more  certain  the  digestion;  conversely  the 
greater  the  volume  of  milk,  the  lower  the  ratio  of  digestive 
ferments  and  the  greater  the  danger  of  bacteria  attaining 
the  upper  hand  and  displacing  digestion  by  bacterial  de- 
composition. Clinically  this  conception  holds  true  and  there 
is  no  more  important  lesson  to  be  learned  in  connection  with 
the  growing  of  calves  (or  other  young)  than  that  feeding 
more  milk  than  can  or  will  be  digested  promptly  is  a  peril  to 
health  and  life.  All  that  milk  which  the  digestive  ferments 
fail  to  prepare  for  assimilation  and  utilization  by  the  body 
for  its  food  is  broken  down  by  the  bacteria  and  causes  harm. 
I  consider  it  highly  important  that  the  milk  fed  to  dairy 
calves,  after  they  are  about  ten  days  old,  be  boiled.  It  is 
virtually  always  mixed  milk  coming  from  a  large  number  of 
cows.  Often  when  there  is  a  bad  udder  or  a  cow  has 
aborted  or  had  retained  afterbirth,  the  milk  is  fed  to  calves. 
Such  milk  is  often  badly  contaminated  with  infectious  dis- 
charges from  the  uterus  which  have  flowed  down  the  tail  and 
thighs.  It  is  safe  when  boiled,  but  otherwise  unsafe.  The 
same  is  generally  true  of  mixed  raw  milk.  It  contains  all 
infections  reaching  the  milk  of  any  cow,  so  that  the  danger 
is  multiplied  by  the  number  of  cows  contributing  to  the 
ration  of  milk  fed.  There  has  been  much  interesting 
controversy  regarding  the  comparative  virtues  of  raw  and 
cooked  milk.  I  consider  that  it  has  been  proven  beyond 
dispute  that  raw  milk  is  in  itself  a  safer  food  for  calves  for 
a  few  days  after  birth  than  cooked  milk.  Various  explana- 
tions have  been  given.  Some  have  said  that  the  essential 
salts  of  the  milk  are  rendered  non-assimilable  by  cooking. 
Others  have  claimed  the  change  is  in  the  fat,  casein,  or  other 
constituent.     Recently  it  has  been  positively  asserted  that 


676  Diseases  of  the  Genital  Organs 

vitamins  are  destroyed  by  cooking  and  the  milk  thereby 
rendered  unfit  to  sustain  life  and  health. 

Experimentally  I  have  fed  numerous  calves  upon  thor- 
oughly boiled  milk.  A  considerable  proportion  of  these, 
probably  one-third,  lived  and  grew  splendidly;  the  others 
quickly  perished  from  dysentery,  arthritis,  or  pyemia.  Those 
which  did  well  showed  health  and  vigor  beyond  that  of 
calves  fed  upon  raw  milk.  The  results  are  partially  illus- 
trated in  Figs.  81  to  84.  They  are  confusing  because  the 
calves  thus  fed  represent  the  extremes,  without  that  middle 
class  of  health  observed  in  calves  fed  on  raw  milk.  A  fur- 
ther study  reveals  the  interesting  fact  that  the  calves  which 
did  well  upon  cooked  milk  came  from  clean  herds  where 
harmful  genital  infections  were  low  or  not  clinically  re- 
cognizable, while  the  calves  which  promptly  sickened  and 
died  came  from  herds  where  genital  infections  were  intense. 
In  other  words,  the  cooked  milk  was  excellent  for  those 
calves  which  were  born  comparatively  free  from  bacteria  in 
the  meconium,  and  highly  perilous  for  those  having  large 
volumes  of  bacteria  in  the  alimentary  tract  when  born.  The 
cooked  milk  was  perfect  as  a  food  but  useless  as  a  bacteri- 
cide. 

My  results  were  in  such  sharp  contrast  with  the  observa- 
tions of  others  that  their  reliability  was  questioned.  Some 
disbelieved  the  effectual  and  reliable  boiling  of  the  milk.  In 
order  to  meet  this  objection,  I  personally  removed  two  calves 
from  their  dams  at  birth,  without  the  dam's  having  so  much 
as  licked  her  young.  These  were  placed  upon  milk  auto- 
claved  for  thirty  minutes  under  fifteen  pounds  of  steam, 
equivalent  to  a  temperature  of  about  240  degrees  F.,  or  28 
degrees  above  boiling.  The  milk  was  browned  to  about  the 
color  of  weak  coffee.  I  believed  that,  if  vitamins  or  other 
essential  constituents  were  destroyed  by  heat,  this  would 
demonstrate  the  fact.  But  the  calves  did  phenomenally  well, 
equalling  in  health  and  rapidity  of  growth  any  I  have  ever 
observed.  The  results  of  the  experiment  are  partly  shown 
in  Figs.  208  to  211  inclusive.  Calf  70  was  extremely  thin, 
weak,  and  sick  at  birth.     She  weighed  forty-nine  pounds. 


Congenital  Infections  of  Calves 


677 


Each  calf  gained  upon  an  average  two  per  cent,  of  its  body 
weight  at  birth  per  day  during  the  experiment.  The  plan 
for  controlling  the  dysentery,  and  at  one  time  threatened 
pneumonia,  is  graphically  shown  in  the  charts.  Neither 
calf  at  any  time  lost  the  lustre  of  its  hair.  After  the  first 
few  days,  they  remained  plump  and  were  unusually  playful. 
In  order  to  accomplish  these  results  with  boiled  milk  with 
any  degree  of  uniformity,  I  have  found  it  necessary  to  ad- 

OHART  OF  CALF   No.  70 


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Fig.  2o8— Chart  of  Calf  No.  70,  fed  upon  autoclaved  milk. 


67S 


Diseases  of  the  Cienital  Organs 


minister  large  quantities  of  calf  scours  serum,  but  I  cannot 
believe  that  this  in  any  way  supplied  any  nutrient  con- 
stituent of  the  milk  destroyed  by  heat.  It  appears  to  me 
quite  clear  that  the  sole  result  of  the  serum  was  the  supply- 
ing of  protective  substances  which  held  in  control  or  destroy- 
ed bacteria  existing  in  the  alimentary  canal  at  birth. 
Further  clinical  evidence  regarding  the  action  of  heat  upon 
the  healthfulness  of  milk  is  furnished  by  placing  the  calf 
Cha-rt  op  Calf  No  70 


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Fig.  20;— Continuation  of  Fig.  208. 


Coyigenital  Infections  of  Calves 


679 


upon  raw  milk  for  ten  or  twelve  days  and  then  placing  it 
upon  boiled  milk.  Such  calves  regularly  do  well,  and  the 
logical  explanation  would  appear  to  be  that  the  raw  milk 
allowed  for  a  limited  time  enables  the  calf  to  develop  a 
resistance  to  the  bacteria  present,  after  which  the  protective 
substances  are  not  required.  As  a  result  of  these  researches 
I  have  advised,  and  have  found  the  advice  good  in  actual 
practice,  that  the  calf  be  fed  raw  milk  from  its  dam  until 


Chart   No  2  ConTinueJ    — 

CHART    OF   CALF    NO  7 

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Fig.  210— Chart  of  Calf  No.  71,  fed  upon  autoclaved  milk. 


68o 


Diseases  of  the  Genital  Organs 


eight  to  ten  days  old,  at  which  time  it  should  be  placed  upon 
boiled  milk,  which  may  be  taken  from  any  cow  or  cows  and 
may  be  whole  or  skimmed.  Pasteurized  milk  has  been  ad- 
vocated as  superior  to  boiled  milk,  but  I  have  been  unable 
to  observe  any  superiority  in  it,  either  in  experiment  calves 
or  when  practically  fed  in  herds. 

Each  new-born  calf  should  be  regarded  as  a  probable  car- 
rier of  infection  dangerous  for  other  young  calves,  should 

.,     ,  ..  _  CHART  OF  Calf  No 71. 


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Fio.  2  1 1.— Continuation  of  Fig.  210. 


Congetutal  Infections  of  Calves  68 1 

direct  or  indirect  contact  occur.  The  proper  growing  of 
calves  demands  an  adequately  isolated  stall  for  each  until  it 
has  reached  a  time  when  its  freedom  from  disease  is  definite- 
ly assured.  Each  establishment  should  be  provided,  as  a 
necessary  part  of  its  equipment,  with  a  sufficient  number  of 
perfectly  isolated  stalls  to  accomodate  all  anticipated  calves 
until  at  least  ninety  days  old,  and  longer  if  appearances  in- 
dicate danger,  or  if  it  is  economically  practicable.  Most 
calf  nurseries  violate  every  rule  of  hygiene  in  construction, 
arrangement,  and  equipment.  They  usually  fall  into  two 
groups.  In  many  instances  the  available  funds  are  used  in 
the  construction  of  an  expensive,  often  extravagant,  dairy 
stable  and  the  young  calves  are  forced  into  some  decaying 
structure  unfit  for  the  occupancy  of  any  animal.  At  the 
other  extreme,  there  have  been  erected  recently  by  very 
wealthy  breeders  extravagant  nurseries  which  in  their  plans 
are  equally  in  conflict  with  the  fundamentals  of  hygiene  es- 
pecially because  the  stall  partitions  are  of  open  work,  so  that 
from  a  hygienic  standpoint  there  is  no  isolation  of  calves. 
The  calves  may  lick  each  other  through  the  partition,  diar- 
rheic  feces  may  be  ejected  into  the  next  stall,  and  sputum 
from  a  pneumonic  calf  thrown  into  it.  A  yet  more  unsani- 
tary practice  is  the  placing  of  two  or  more  young  calves  in  a 
common  stall.  When  some  of  these  become  ill,  sputum  and 
feces  soil  the  bedding,  floor,  feeding  utensils,  the  exterior  of 
the  calves,  the  food,  stalls,  and  fixtures.  The  calves  lick  and 
suck  each  other  and  transfer  from  one  to  the  other  any 
infections  present.  Frequently  an  infected  calf  will  suck 
the  navel  of  another  and  infect  it.  The  infected  navel  will 
be  sucked  and  later  the  calf  which  is  sucking  will  move  to 
the  udder  and  suck  it,  transferring  the  infection  to  the  teats. 
The  infection  passes  up  the  teat  canal  causing  a  small  ab- 
scess, and  when  the  heifer  is  grown  and  calves,  one  or  more 
quarters  of  the  udder  are  blocked  and  the  animal  is  of  low 
value. 

The  simplest  type  of  nursery  to  conform  to  hygienic  prin- 
ciples is  one  with  two  rows  of  stalls,  one  row  against  each 
side  with  a  broad  aisle  between.     The  stalls  for  the  youngest 


682  Diseases  of  the  Genital  Organs 

calves  should  be  six  by  eight  feet,  with  larger  stalls  to  which 
they  may  be  shifted  later,  with  solid  partitions  (wood  or 
concrete) .  The  aisle  side  should  be  open  and  provision  made 
at  the  opposite  side  for  a  free  opening  near  the  level  of  the 
floor  (door  or  window) ,  so  that  in  warm  weather  there  may 
be  a  free  passage  of  air  through  the  stall  at  the  floor  level. 
The  floor  should  be  of  concrete  or  other  impervious  material 
which  will  freely  admit  of  washing  and  disinfection. 

The  heating  of  the  nursery  has  generally  proven  a  failure. 
Any  attempt  to  heat  the  room  with  overhead  steam  pipes 
has,  in  my  observation,  heated  the  upper  air,  kept  flies  alive 
all  winter,  and  made  concrete  and  similar  floors  cold  and 
damp.  An  ordinary  stove  is  somewhat  better,  but  it  is 
dangerous  and  the  heat  diffuses  slowly  and  imperfectly. 
Neither  of  these  plans  supplies  warmth  where  it  is  most 
needed — ^the  cold  and  usually  damp  floor — and  neither  ad- 
mits of  free  circulation  of  air  without  most  of  the  heat  pass- 
ing out  of  the  room.  I  have  found  hot  water  pipes  laid  be- 
neath the  concrete  floor  and  properly  operated  highly  satis- 
factory. The  capacity  of  the  heater  should  be  very  low 
compared  with  the  cubic  content  of  the  room,  as  a  safe- 
guard against  overheating.  The  pipe  should  be  large,  either 
cast  iron  water  pipe  or  sewer  tile  carefully  laid.  There 
should  be  but  a  single  loop  of  pipe  beneath  each  tier  of  stalls. 
With  such  a  system  installed,  little  heat  is  required  to  warm 
the  floor,  and,  once  it  is  warmed,  heat  is  retained  for  a  long 
period.  The  floor  upon  which  the  calf  lies  is  kept  warm 
and  dry  while  the  general  temperature  of  the  stable  may  be 
kept  low  and  the  exchange  of  air  abundant.  The  interior 
of  the  stable,  stalls  and  fixtures  should  be  unpainted,  or  at 
least  not  painted  with  lead  or  zinc.  Possibly  zinc  is  not  in 
itself  poisonous,  but  it  is  rarely  or  never  free  from  lead.  In 
fashionable  stables  many  calves  die  from  licking  painted 
walls  or  fixtures,  and  sometimes  feed  pails. 

Throughout  the  milk-feeding  period  the  condition  of  the 
calf  should  be  watched  closely.  It  should  not  bo  permitted 
to  become  gaunt  or  pot-bellied.  The  feces  of  a  sound,  vigor- 
ous calf  do  not  adhere  to  its  tail  and  buttttcks.     Upon  the 


Congenital  Infections  of  Calves  683 

first  sign  of  this,  the  fault  should  be  corrected.  Very  largely 
it  is  too  much  milk,  at  least  too  much  for  the  calf  in  ques- 
tion. The  milk  supply  should  therefore  be  decreased  and 
care  should  be  taken  to  see  that  it  is  clean,  and,  if  boiled, 
that  the  boiling  has  been  efficient.  At  the  same  time,  if 
conditions  at  all  justify,  calf  scours  serum  should  again  be 
given  or,  often  with  better  effect,  bacterins  made  from  cul- 
tures from  its  feces  or  stock  cultures  from  the  herd.  In 
such  cases  enemas  of  salt  solution,  as  recommended  at  birth, 
repeated  twice  daily,  are  useful. 

As  an  economic  measure,  in  order  that  the  milk  may  be 
sold  on  the  market,  substitute  foods  have  been  recommend- 
ed. There  can  be  no  material  objection  to  them  if  they 
maintain  the  condition  of  the  calf  as  well  as  good  clean 
milk,  no  more  than  there  should  be  objection  on  the  part  of 
the  dairyman  to  synthetic  milk  or  butter  placed  upon  the 
market  for  human  use.  I  think  it  has  not  yet  been  shown 
that  any  substitute  can  equal  good  milk  in  either  field, 
though  a  good  substitute  may  be  superior  to  bad  milk.  The 
calf  may  have  supplementary  foods  very  early,  perhaps 
most  profitably  oatmeal  or  linseed  meal  in  moderate  amount. 
When  these  infections  have  been  neglected  and  a  calf  per- 
mitted to  become  feeble,  abscesses  occur  in  the  lips  and 
cheeks.  The  underlying  infection  must  be  handled  first. 
The  abscesses  should  be  opened  early  and  freely  and  they,  or 
any  ulcers,  cauterized  with  silver  nitrate  or  sulphate  of 
copper.  Calves  suffering  from  dysentery  or  lesser  alimen- 
tary disturbances,  acquire  morbid  appetites  and  swallow 
straw,  hay,  feces,  shavings  (bedding),  and  various  in- 
digestible substances.  The  abnormality  is  probably  never 
seen  in  a  healthy  calf.  If  it  proceeds  far,  there  are  usually 
very  severe  symptoms,  which  are  often  confusing.  Some- 
times the  presence  of  indigestible  material,  usually  packed 
into  a  large  dense  mass  in  the  stomach,  causes  an  obstinate 
dysentery  against  which  all  remedies  are  futile.  Some- 
times the  masses  pass  on  into  the  intestine  and  become  im- 
pacted there.  In  some  cases  the  calf  has  severe  convulsions 
similar  to  those*due  to  lead  poisoning  from  licking  paint.    If 


684  Diseases  of  the  Genital  Orgayis 

the  tendency  is  discovered  early,  the  danger  may  be  halted 
by  adequate  muzzling.  If  the  rubbish  swallowed  has  been 
extensive,  it  is  beyond  known  remedy  unless,  if  the  diagnosis 
is  clear,  one  may  attempt  gastrotomy. 

If  the  breeder  insists  upon  permitting  the  calf  to  nurse 
the  cow,  he  should  be  induced,  if  possible,  to  milk  the  cow 
almost  dry  and  to  wash  and  disinfect  the  udder  before  the 
calf  is  permitted  to  suck.  Where  the  calf  must  run  with  the 
cow,  the  feeding  cannot  be  controlled  and  the  handling  of 
this  group  of  infections  cannot  be  so  satisfactory.  In  beef 
cattle,  especially  purebreds,  and  in  grade  cattle  which  are 
partially  milked,  the  feeding  problem  may  in  many  cases 
be  satisfactorily  managed.  If  the  cows  are  gentle,  they  may 
be  milked  out  to  that  point  where  approximately  the  ration 
advised  is  left  in  the  udder,  and  the  calf  then  permitted  to 
suck.  When  the  calf  is  ten  days  old,  it  will  usually  con- 
sume with  safety  and  profit  all  its  dam  will  yield.  In  beef 
cows  the  milk  ration  may  be  reduced  at  first  by  feeding  the 
cow  very  low  or  by  placing  her  on  very  poor  pasture. 

In  some  herds  of  beef  cattle  I  have  observed  that  the  con- 
genital infections  do  not  tend  so  strongly  to  induce  diarrhea 
as  in  dairy  calves.  Instead,  the  calves  appear  languid, 
breathe  rapidly  (fever),  have  little  or  no  appetite,  and  die. 
Upon  autopsy,  the  lesions  are  the  same  in  general  as  in 
dysentery :  that  is,  there  are  hemorrhages  in  various  tissues 
and  the  feces  are  soft  and  fetid.  The  calf  running  in  the 
open  may  also  acquire  a  morbid  appetite,  and  may  swallow 
dry  grass  or  other  rubbish,  have  convulsions  and  die.  For 
these  reasons  I  have  had  occasion  to  advise,  with  gratifying 
results,  the  use  of  calf  scours  serum,  as  in  the  dysentery 
of  dairy  calves,  making  its  administration  a  general  rule  in 
herds  where  calves  are  dying.  In  purebred  beef  cattle  ex- 
cellent results  are  obtainable  by  separating  the  new-born 
calf  immediately  after  birth,  muzzling  it  securely,  and  re- 
moving the  muzzle  twice  daily  to  let  the  calf  suck,  after  the 
dam  has  been  well  milked  out.  When  dysentery,  arthritis, 
pneumonia,  or  other  phenomena  are  established,  or  when,  in 
the  hands  of  the  alert  breeder  the  temperature,  blood  in  the 


Conge7iital  hifections  of  Calves  685 

feces,  or  other  signs  betoken  the  approaching  storm,  all 
food  should  be  withdrawn.  Most  persons  temporize  by  re- 
ducing the  ration.  That  is  not  enough.  The  small  ration  is 
of  no  value  whatever  to  the  calf.  Instead,  the  food  is  broken 
up  by  the  bacteria,  producing  toxic  substances  which  in- 
jure the  calf.  It  is  almost  impossible  to  have  some  persons 
understand  that  milk  is  food  only  when  digested  by  the 
physiologic  ferments  and  that  it  is  just  as  imprudent  to 
feed  fresh,  clean  milk  to  a  calf,  when  it  will  undergo  bac- 
terial decomposition  in  the  stomach,  as  it  would  be  to  inoc- 
ulate the  milk  with  the  same  bacteria,  incubate  it  until 
thoroughly  and  repulsively  decomposed,  and  then  compel  the 
calf  to  drink  it. 

The  calf  should  receive  immediately  large  and  repeated 
doses  of  calf  scours  serum.  There  is  no  limit  to  the  amount 
which  may  be  given.  It  is  best  as  a  rule  to  give  30  to  50 
mils  at  a  dose,  and  this  may  be  repeated  in  two  or  three 
hours  as  long  as  desired.  It  is  best  and  most  economic  to 
meet  the  violent  onset  of  the  disease  with  vigorous  opposi- 
tion rather  than  to  temporize  with  small  or  infrequent  doses. 
It  is  safer  for  the  calf  and  more  economical  to  control  the 
onset  of  the  disease  quickly.  If  the  disease  is  controllable, 
it  can  be  overcome  within  two  to  six  hours,  if  the  dosage 
is  sufficiently  liberal,  and  the  total  volume  of  serum  required 
will  be  less  than  if  used  in  smaller  doses  over  a  period  of 
twelve  to  twenty-four  hours.  Calf  scours  serum  generally 
appears  to  act  specifically,  and,  when  administered  in  time 
and  in  sufficient  volume,  gives  highly  favorable  results.  The 
calf,  even  when  lying  prostrate  upon  its  side,  unconscious, 
its  temperature  subnormal,  and  fetid  watery  feces  dribbling 
away  involuntarily,  often  responds  at  once  and  may  be  on  its 
feet  and  well  advanced  toward  recovery  within  two  to  four 
hours.  When  severe  arthritis  is  present,  heavy  dosage  may 
cause  the  articular  pain  and  swelling  to  disappear  almost 
wholly  in  a  few  hours.  There  are  numerous  exceptions. 
When  the  disease  is  not  taken  in  hand  until  far  advanced, 
the  mortality  is  unavoidably  high.  In  some  outbreaks  the 
disease  appears  uncontrollable  with  serum  or  other  known 


686  Diseases  of  the  Genital  Orgayis 

remedy.  Several  reasons  have  been  suggested.  In  many 
cases  the  failure  is  unquestionably  due  to  a  blind  reliance 
upon  serum  without  the  basic  act  of  withdrawing  all  food 
and  attending  to  other  essential  features,  such  as  the  pre- 
vention of  the  swallowing  of  rubbish.  Numerous  writers 
have  contended  that  the  obstinacy  in  some  outbreaks  is  over- 
powering because  the  infection  is  specifically  different  from 
the  prevailing  cause  of  dysentery,  pneumonia,  or  arthritis, 
the  bacteria  of  which  have  been  used  in  building  up  the  cura- 
tive serum.  To  prevent  this,  some  biologic  houses  have  as- 
sembled a  great  medley  of  bacteria,  in  order  to  produce  a 
serum  which  may  quite  certainly  contain  the  one  specific 
cause  in  any  outbreak.  It  is  the  continuation  of  the  old 
"shotgun"  therapy  based  upon  the  philosophy  that,  if  the 
charge  scatters  sufficiently,  some  one  shot  will  hit  the  mark. 
To  be  perfectly  frank  in  the  matter,  it  has  not  been  shown 
that  the  building  up  of  the  resistance  of  the  horse,  by  in- 
jecting various  bacteria  before  drawing  the  serum,  has  ex- 
erted the  least  effect  upon  the  value  of  the  serum.  Accord- 
ing to  my  observations,  calf  scours  serum  acts  specifically 
and  highly  beneficially  in  the  cases  under  consideration,  but 
no  control  experiments  have  been  made  and  it  is  not  known 
that  serum  from  an  ordinary  horse  not  treated  by  artificial 
inoculation  with  bacteria  is  not  just  as  potent  and  valuable 
as  the  preparations  upon  the  market.  Indeed  some  recent 
researches  by  my  colleague.  Carpenter,  appear  to  indicate 
that  this  is  true.  It  is  not  improbable  also  that  the  serum 
or  blood  from  the  dam  of  the  calf  is  a  potent  agent,  possibly 
the  best  substance  available.  This  too  has  been  tried  by 
Carpenter  with  promising  results.  It  has  not  been  shown 
that  any  organism  used  by  the  various  producers  of  biologies 
in  immunizing  horses  for  the  production  of  calf  scours  serum 
has  any  basic  relation  to  calf  dysentery  or  pneumonia.  The 
makers  of  serum  have  largely  depended,  for  making  serum, 
upon  colon  organisms  obtained  from  calves  dead  of  dysen- 
tery or  pneumonia,  instead  of  going  where  they  clearly 
should  go,  to  the  fetus,  for  their  ferment.  The  whole 
scheme  of  serologic  handling  of  calf  dysentery  and  pneu- 


General  Infections  of  the  Genitalia  as  a   WJiole  687 

monia  rests  upon  very  insecure  ground,  and  may  at  any 
date  be  supplanted  by  more  effective  and  economic  methods. 
Pending  definite  knowledge  of  the  fundamental  biology  of 
calf  dysentery  and  pneumonia,  or  the  definite  establishment 
of  a  more  efficient  method,  the  present  serum  method  should 
be  accepted  as  the  standard,  applied  intelligently  and  freely, 
and  given  full  credit  for  its  undoubted  value,  whatever  may 
be  the  origin  of  that  value. 

The  Problem  of  the  General  Infections  of  the 
Genitalia  as  a  Whole 

Throughout  the  discussion  of  the  general  genital  infec- 
tions of  cattle,  the  various  lesions  have  been  considered 
separately  and  in  detail,  while  striving  constantly  to  re- 
gard them  as  related  units  expressing  variations  in  the 
ravages  of  the  infections  according  to  their  virulence,  the 
organ  involved,  the  period  of  invasion,  and  the  differences  in 
environment.  It  is  futile  to  handle  cervicitis  in  the  cow  due 
to  streptococcic  spermato-cystitis  in  the  bull  with  which  she 
copulates.  It  is  useless  to  rave  over  "contagious  abortion" 
in  one  cow  and  ignore  retained  fetal  membranes  in  another 
due  to  the  same  organism.  It  is  idle  to  handle  calf  dysen- 
tery which  the  calf  has  acquired  from  the  uterus  of  its  dam, 
without  trying  to  heal  the  diseased  uterus. 

Many  writers  cry  out  that  "contagious  abortion"  is  caus- 
ing tremendous  losses,  that  its  ravages  are  constantly  grow- 
ing more  serious,  and  that  unless  halted  it  will  soon  ruin  the 
dairying  and  cattle  breeding  industry.  They  are  right.  The 
theories  they  promulgate  are  the  foundation  of  the  peril. 
So  long  as  sterility,  abortion,  retained  fetal  membranes, 
metritis,  calf  sepsis,  dysentery,  pneumonia,  and  the  endless 
list  of  other  phenomena  of  this  great  group  are  described 
as  distinct,  independent  maladies  and  their  relation  to  each 
other  denied  or  ignored,  all  the  phenomena  of  the  group  will 
increase.  The  multitude  of  lesions  and  phenomena  described 
in  the  preceding  pages  are  not  distinct  diseases  in  any  true 
sense.  Each  of  them  might  better  be  likened  to  bricks  and 
mortar  which,  when  properly  combined  and  arranged,  con- 
stitute a  structure  of  tremendous  importance. 


688  Diseases  of  the  Genital  Organs 

I  have  purposely  given  the  genital  infections  of  cattle  the 
first  place  in  this  treatise,  because  they  lead  in  importance  in 
the  economic  interests  of  the  owner  and  the  state,  and  in 
regard  to  human  health.  At  the  same  time  they  serve  ad- 
mirably as  a  basis  for  comparative  study  of  the  genital  infec- 
tions of  other  species. 

There  is  pressing  need  for  the  building  up  of  a  compre- 
hensive plan  where  the  dairyman,  cattle  breeder,  and  veter- 
inarian may  meet  upon  common  ground  and  intelligently 
apply  effective  measures  for  the  control  of  these  appalling 
losses.  The  problem  is  many-sided  and  intricate.  Most 
lamentable  of  all,  but  little  is  actually  known  regarding  it. 
Enough  is  known  however  to  warrant  the  unqualified  de- 
claration that  means  are  at  hand,  and  are  being  applied  in 
many  cases,  which  are  minimizing  the  losses  in  a  highly 
gratifying  degree  and  giving  promise  of  great  advancement 
with  conscientious  study  and  intelligent  cooperation. 

In  the  scheme  which  has  been  followed  in  the  preceding 
pages  and  which  is  summarized  below,  the  B.  abortus  of 
Bang  is  not  recognized  as  the  specific  cause  of  abortion  or 
other  disease,  but  it  is  not  denied  that  it  may  cause  abortion. 
At  the  same  time  it  is  held  that  other  bacteria  within  the 
genital  organs  may  and  do  cause  lesions  not  distinguishable 
at  present  from  those  alleged  to  be  caused  by  the  Bang  or- 
ganism. The  plan  for  advancing  the  fertility  of  cattle  has, 
therefore,  for  its  aim  the  destruction  or  control  of  all  patho- 
genic bacteria  invading  any  of  the  genital  organs  of  either 
sex,  at  any  age.  Such  a  plan  does  not  weaken  but  strength- 
ens the  efficiency  of  the  control  of  the  B.  abortus  infection, 
and  more  certainly  eliminates  or  minimizes  the  latter  than 
if  measures  were  applied  to  it  alone. 

A.  The  Assembling  of  Herds,     The  Addition  of  Breeding 

Animals  to  Established  Herds 

The  task  of  selecting  animals  to  constitute  the  foundation 

of  a  herd  and  the  addition  of  animals  to  an  established  herd 

for  the  purpose  of  improving  it,  is  a  complex  and  dillirult 

problem.     Most  purebred  cattle  are  purchased   upon   their 


The  Assembling  of  Herds  689 

pedigrees,  including  their  show  and  dairy  records,  and  upon 
their  individual  appearance.  In  purchasing  cattle  the  buyer 
should  recognize  certain  fundamental  principles. 

1.  Pedigree  is  of  no  value  unless  supported  by  fertility. 
In  order  to  be  fertile  the  animal  must  be  physically  sound. 
If  any  chronic  disease,  such  as  tuberculosis,  is  present,  the 
fertility  of  the  animal  is  lowered  or  destroyed.  Some  cows 
and  bulls  with  tuberculosis  breed,  it  is  true,  but  when  a 
large  number  of  tubercular  animals  is  assembled  the  group, 
as  such,  shows  low  fertility.  Besides,  the  disease  is  a  gen- 
eral menace  to  the  herd.  The  laws  and  customs  of  sale 
now  safeguard  the  buyer  fairly  well  in  many  states.  The 
laws  also  forbid  the  sale  of  animals  with  such  acute  infec- 
tions as  anthrax.  There  are  no  laws,  and  no  laws  are  pos- 
sible of  enactment,  which  can  adequately  protect  the  buyer 
against  the  diseases  of  the  genital  organs  which  may  inter- 
fere with  or  destroy  the  reproductive  power  of  the  animal. 
At  the  same  time  the  genital  infections  constantly  threaten 
to  pass  from  a  diseased  individual  to  another  which  is  sound 
or  to  one  which  carries  a  less  perilous  infection. 

2.  The  buyer  should  assume  that  the  cattle  in  all  herds 
carry  infections  in  their  genital  organs  which  may  ulti- 
mately lead  to  sterility,  abortion,  retained  afterbirth,  calf 
scours,  and  other  unwelcome  phenomena.  He  should  further 
realize  that  there  are  vast  differences  in  the  virulence  of 
infections  in  the  cattle  of  different  herds  and  of  different  in- 
dividuals in  the  same  herd.  In  some  herds  the  infections 
are  so  mild  that  little  or  no  visible  harm  comes  from  their 
presence;  in  others  the  reproductive  efficiency  falls  so  far 
below  the  ideal  that  the  herd  is  economically  a  dismal  fail- 
ure.   Between  these  extremes  there  is  every  gradation. 

3.  The  prospective  buyer  should  not  expect  the  average 
seller  to  volunteer  all  information  regarding  diseases  among 
his  cattle  interfering  with  reproduction.  Each  herd  of  size 
has  cows  which  have  aborted  because  of  contagion,  but  no 
breeder  posts  a  sign  on  his  stable  giving  notice  to  the  public 
that  he  has  "contagious  abortion"  in  his  herd.  Some  bacte- 
riologists come  to  the  aid  of  the  breeder  by  asserting  that 

44 


690  Diseases  0/  the  Genital  Organs 

B.  abortus  is  the  cause  of  abortion  and  that  it  disappears 
from  the  uterus  of  an  aborter  very  shortly  after  the  disaster. 
If  then  a  cow  aborts  and  the  abort  and  its  membranes  are 
burned  or  buried,  the  stall  disinfected,  and  the  cow  quaran- 
tined for  a  brief  interval,  the  infection  is  controlled  and 
from  such  standpoint  the  seller  may  declare  he  has  no  "con- 
tagious abortion"  on  his  premises — but  he  may  have  an  hour 
or  two  later.  The  buyer  should  not  exercise  himself  seriously 
concerning  "contagious  abortion,"  but  should  try  to  deter- 
mine whether  the  animals  he  wishes  to  purchase  are  capable 
of  begetting  or  of  giving  birth  to  healthy  calves. 

4,  Intelligent  breeders  aim  to  retain  their  best  cattle  and 
to  discard  the  least  valuable.  It  is  only  when  a  breeder  ex- 
ceeds his  holding  capacity  for  good  animals  that  he  becomes 
desirous  of  selling  some  of  them.  It  is  commonly  assumed 
that  the  breeder  of  purebred  cattle  has  a  far  greater  ca- 
pacity for  profitably  holding  females  than  males.  The  dif- 
ference has  been  vastly  overdrawn,  owing  to  reproductive 
inefficiency.  Thoroughly  healthy  cows  breed  regularly  up  to 
twenty  years  and  often  beyond.  Ideally  each  cow  should 
produce  one  healthy  calf  each  twelve  months.  If  she  gives 
birth  to  her  first  calf  at  two  years  and  breeds  ideally  up  to 
and  including  her  thirteenth  year,  she  will  have  produced 
twelve  calves,  six  of  which,  upon  the  average,  will  have  been 
males  and  six  females.  At  the  close  of  the  thirteenth  year, 
it  will  be  necessary  to  have  in  reserve  one  adult  from  her 
six  female  calves  to  replace  the  worn-out  original  cow,  and 
there  will  remain  for  disposal  (or  for  herd  expansion)  six 
males  and  five  females. 

When  the  average  breeding  life  of  the  females  in  a  herd 
falls  below  six  years  and  the  average  number  of  progeny 
falls  below  four,  the  preponderance  of  males  over  females 
offered  for  sale  by  the  breeder  becomes  very  marked.  He 
must  in  the  latter  case  retain  fifty  per  cent,  of  his  female 
progeny  to  replace  the  toll  exacted  by  disease,  whereas, 
with  the  ideal  cow  of  thirteen  years  with  twelve  calves,  he 
retains  but  16  2/3  per  cent,  of  his  female  progeny  to  main- 
tain his  herd  status.   The  breeder  having  a  herd  of  low  olli- 


The  Assembling  of  Herds  691 

ciency  sells  only  inferior  females,  while  the  owner  of  an  effi- 
cient herd  must  find  a  market  for  superior  animals.  In  a 
healthy  herd  the  limit  for  profitably  holding  cows  and  heifers 
is  quickly  reached,  since  ideally  the  female  herd  increases 
by  one  half  its  number  of  females  of  breeding  age  each  year. 
That  is,  a  herd  of  one  hundred  cows  should  ideally  produce 
fifty  heifer  calves,  and  the  second  year  another  fifty.  Since 
in  the  third  year  the  first  fifty  heifer  calves  are  in  breeding, 
there  should  be  born  seventy-five  female  calves,  and  the  next 
year  one  hundred.  The  progress  in  numbers  goes  on  with 
increasing  momentum.  The  actually  successful  breeder  must 
quickly  find  a  market  for  his  females,  and  must  sell  those  of 
good,  as  well  as  of  poor  quality.  When,  therefore,  the  owner 
of  an  old  established  herd  advertises,  "No  females  for 
sale,"  he  unwittingly  announces  very  low  fertility  and  a 
very  dangerous  herd  from  which  to  buy  cattle  of  any  age  or 
of  either  sex  for  breeding. 

5.  In  purchasing  a  foundation  herd  the  entire  group  of 
animals  should,  if  possible,  be  purchased  from  one  breeder. 
In  this  manner  one  avoids  the  risk  of  bringing  into  contact 
animals  from  numerous  sources,  each  source  possibly  fur- 
nishing a  different  type  of  infection  of  the  genital  organs. 
The  difficulty  of  determining  the  state  of  health  of  the  pur- 
chased animals  increases  as  their  sources  multiply.  Pur- 
chasing the  foundation  stock  from  a  single  herd  simplifies 
the  question  of  warranty.  If  a  heifer  or  cow  fails  to  con- 
ceive, the  seller  of  the  group  cannot  shift  the  blame  to  the 
bull,  since  he  has  made  a  warranty  on  him  also.  This  plan 
is  also  best  for  the  seller  both  in  fact  and  in  policy.  When  a 
breeder  sells  a  large  group  of  females  without  depleting  his 
herd,  he  gives  indisputable  evidence  of  the  sexual  sound- 
ness of  his  cattle,  which  another  prospective  buyer  of  a 
single  sire  for  his  established  herd  may  accept  as  good  evi- 
dence that  he  is  being  offered  a  sound  bull. 

6.  The  best  place  for  a  buyer  to  go  to  learn  of  the  health 
of  the  herd  from  which  he  contemplates  purchasing  stock  is 
to  the  nursery.  If  a  large  number  of  calves,  in  proportion 
to  the  number  of  cows  in  the  herd,  is  present  and  the  calves 


6g2  Diseases  of  the  Genital  Organs 

under  four  months  of  age  are  vigorous  and  healthy,  the  herd 
is  a  comparatively  safe  one  from  which  to  purchase.  If  the 
number  of  calves  is  low,  and  they  are  gaunt  or  pot-bellied, 
with  dirty  rough  coats,  or  their  tails  are  smeared  with  feces, 
the  herd  is  an  unsafe  one  from  which  to  buy.  In  such  herds 
no  animals  may  be  shown  for  sale  until  over  three  to  four 
months  old,  when  perhaps  they  have  attained  apparent  vigor. 
This  should  not  deceive  the  alert  buyer.  The  breeding  health 
of  the  herd  should  be  based  upon  the  comparative  number  of 
calves  and  their  health  up  to  one  hundred  and  twenty  days 
old. 

7.  The  prospective  purchaser  should  regularly  guard  his 
interests  by  having  a  skilled  veterinarian  examine  in  detail 
the  genital  organs  of  each  animal  prior  to  completing  a  pur- 
chase. If  a  bull  is  of  breeding  age,  it  is  best  to  add  to  a  thor- 
ough manual  examination  of  his  genital  organs,  a  micro- 
scopic examination  of  his  semen  with  reference  to  the  num- 
ber, motility  and  conformation  of  the  spermatozoa  as  well  as 
a  search  of  his  semen  for  bacteria.  The  method  of  making 
such  examinations  has  already  been  considered.  The  genital 
organs  of  cows  and  heifers  should  be  examined  per  vaginam 
and  rectum.  If  a  heifer  has  been  bred  thirty  or  more  days, 
or  a  cow  sixty  or  more  days,  the  veterinarian  can  determine 
if  she  is  pregnant.  Such  examinations  should  not  displace 
or  affect  warranty.  If  disease  of  the  genital  organs  is  pres- 
ent, the  prospective  purchaser  does  not  wish  the  animal, 
whatever  warranty  may  be  offered.  Frequently  absolutely 
and  incurably  sterile  females  are  conscientiously  sold  as 
pregnant.  Occasionally  an  animal  without  genital  organs  is 
sold  as  a  pregnant  heifer  or  as  a  heifer  capable  of  breeding. 
It  is  best  to  settle  such  cases  before  purchase  occurs, 

8.  The  progressive,  conscientious  breeder  should  have 
complete  orderly  breeding  records  for  each  animal  and  for 
the  herd  as  a  whole.  These  records  should  be  frankly  open 
for  inspection  to  any  prospective  buyer.  If  a  cow  has  been 
bred  three  or  four  times  in  order  to  secure  pregnancy,  the 
prudent  purchaser  will  not  buy,  whether  she  is  pregnant  or 
not,  or,  if  he  buys,  should  weigh  fully  the  risk.  Such  an  ani- 
mal should  be  purchased  at  a  c()nii)aratively  low  (igiire. 


The  Assembling  of  Herds  693 

9.  The  purchaser  should  demand  and  receive  for  each 
animal  a  specific  written  warranty.  If  an  animal  is  being 
purchased  as  pregnant,  she  should  be  warranted  as  pregnant 
at  a  stated  date  and  place  of  delivery,  and,  failing  in  the 
terms  of  such  warranty,  the  purchase  price  should  be  re- 
turned. This  may  sometimes  be  modified  by  agreement  at 
the  time  of  purchase  and  made  a  part  of  the  contract,  by 
which  an  alternate  animal  is  named,  which,  in  case  the 
original  fails,  may  be  substituted  at  an  agreed  price.  The 
plan  which  some  breeders  try  to  carry  out  of  substituting 
another  animal  "equally  good",  in  case  of  breach  of  war- 
ranty, is  unsatisfactory,  and  the  buyer  should  see  that  no 
such  condition  enter  into  a  bill  of  sale.  If  an  animal  sold 
for  breeding  purposes  and  so  warranted  by  the  breeder  is 
unfertile,  the  purchase  price  morally  and  legally  belongs  to 
the  purchaser  and  should  be  paid  as  promptly  as  a  banker 
honors  a  check  against  a  deposit.  A  warranty  of  pregnancy 
should  ordinarily  apply  to  the  date  of  delivery  only  if  deter- 
mined by  veterinary  examination.  If  the  determination  is 
not  made  by  such  examination,  a  warranty  of  pregnancy  is 
unsatisfactory.  If  a  breeder  believes  he  has  sold  a  pregnant 
cow  or  heifer  and  the  purchaser  reports  later  that  she 
proved  non-pregnant,  the  breeder  may  believe  that  she  has 
aborted  and  that  consequently  the  warranty  was  fulfilled. 

Warranty  against  the  phantom  disease  of  "contagious 
abortion"  is  impracticable  and  may  lead  to  endless  litigation. 
There  is  no  legal  definition  of  "contagious  abortion",  no  sci- 
entific definition  of  it  given  or  possible,  and  no  means  of 
diagnosis  which  is  applicable  in  the  exchange  of  cattle.  This 
question  has  already  been  discussed  at  length.  I  think  it 
best  neither  to  demand  nor  give  a  warranty  against  abortion. 
The  warranty  had  best  be  limited  to  one  of  three  conditions : 
the  female  is  fertile,  she  is  pregnant,  or  she  will  give  birth 
to  a  calf  at  an  approximately  given  date.  These  three  items 
are  each  definable  and  determinable. 

The  warranty  of  fertility  should  definitely  apply  to  the 
point  of  destination — not  to  the  place  of  sale.  A  purchaser 
in  California  has  no  use  for  a  heifer  or  bull  which  is  said  to 


694  Diseases  of  the  (Jcniial  Organs 

be  fertile  in  Maine  but  proves  to  be  unfertile  after  transpor- 
tation to  the  purchaser's  premises.  In  one  case,  where  suit 
was  brought  by  a  buyer  on  the  Pacific  coast  against  a  breeder 
on  the  Atlantic  coast,  the  latter  set  up  the  plea  that  the  trans- 
continental journey  had  destroyed  the  fertility  of  a  young 
bull.  Many  sympathetic  breeders  were  brought  into  court 
who  swore  that  railway  journeys  frequently  render  fertile 
bulls  sterile.  The  jury  failed  to  agree.  Unquestionably  the 
bull  was  absolutely  sterile  on  the  day  of  the  sale  and  had  al- 
ways been  sterile.  The  statutes  of  the  state  made  the  sale 
of  the  bull  for  breeding  purposes  a  warranty  of  fertility. 
Had  there  been  an  explicit  written  warranty  of  fertility  to 
the  buyer,  whose  address  was  known  to  the  seller,  no  such 
claptrap  evidence  could  have  had  weight. 

In  the  present  state  of  the  health  of  cattle,  the  purchaser 
should  also  require  a  warranty  against  tuberculosis  to  the 
extent  that  the  animal  shall  pass  a  satisfactory  tuberculin 
test  after  it  has  reached  its  destination.  A  tuberculin  test 
upon  the  breeder's  premises  is  his  test  for  his  use.  He  must 
make  that  now  for  interstate  shipment.  A  test  at  destina- 
tion is  the  purchaser's  test  for  his  security.  The  breeder  is 
entitled  to  satisfactory  assurance  that  infection  in  transit 
or  at  destination  will  not  occur  and  that  the  tuberculin  test 
will  be  fair. 

B.  The  Equipment  for  Cattle  Breeding  and  Dairying. 
Proper  equipment  is  a  fundamental  necessity  in  the  grow- 
ing of  healthy  cattle  or  other  animals.  The  plans  should  be 
such  as  to  afford  the  highest  possible  general  and  sexual 
health  of  the  animals.  There  is  an  irrevocable  law  that,  the 
greater  the  mass  of  animals  and  the  more  intimately  they 
are  brought  into  contact  without  special  hygienic  provisions, 
the  greater  the  ravages  of  disease.  If  it  is  desired  to  establish 
a  large  herd,  special  provision  needs  to  be  made  against  the 
dangers  of  its  largeness.  Aside  from  the  highly  contagious 
maladies  like  foot-and-mouth  disease,  which  the  state  regu- 
lates, contagious  or  infectious  diseases  are  chiefly  spread 
through  the  eating  of  contaminated  food  or  through  sex  con- 


Equipment  for  Cattle  Breeding  and  Dairying  695 

tact.  The  breeder,  or  dairyman  should  therefore  concentrate 
his  energies  upon  these  two  perilous  points  of  contact,  in  his 
planning  for  the  conduct  of  a  herd.   The  hygiene  of  massed 
individuals  has  had  by  far  the  highest  development  in  the 
human  family,  v^here  the  first  principle  is  that,  however  near 
the  individuals  of  a  great  mass  shall  approach  each  other, 
each  shall  preserve  its  identity  and  in  an  important  sense 
remain  isolated — each  shall  have  separate  eating  and  drink- 
ing equipment,  the  excreta  from  one  individual  shall  not 
contaminate  the  water  or  food  of  the  mass,  the  sputum  of 
the  individual  shall  not  be  cast  upon  the  floor  or  elsewhere 
to  dry  up,  turn  to  powder  and  be  inhaled  by  others.   These 
are  not  principles  of  human,  but  of  universal  hygiene.   The 
more  thoroughly  the  cattle  breeder  applies  these  principles, 
the  better  the  health  of  his  cattle.     Many  cattle  may  be 
safely  assembled  in  a  small  area,  if  proper  regard  is  had 
for  these  principles.    The  number  of  healthy  cattle  which 
may  be  safely  assembled  in  close  contact  is  unlimited.   The 
danger  arises  from  the  introduction  of  one  or  more  animals 
which  are  bearers  of  disease.    In  planning  an  establishment 
for  cattle  breeding  or  dairying,  the  plans  should  receive 
greatest  emphasis  at  the  chief  points  of  danger.    Two  of 
these  demand  special  thought  in  relation  to  equipment — the 
nursery  and  the  maternity  stable.   The  nursery  has  already 
been  discussed  under  the  "Congenital  Diseases  of  Calves". 
Each  establishment  where  cattle  are  stabled  should  have 
sufficient  maternity  stalls  to  accommodate  each  cow  or  heifer 
at  the  termination  of  pregnancy  for  a  period  of  at  least  ten 
days.    The  stalls  should  be  commodious,  comfortable,  and 
capable  of  being  readily  and  efficiently  disinfected.     As  in 
the  calf  stalls,  the  partitions  between  the  maternity  stalls 
should  be  perfectly  tight  and  afford  complete  isolation.     A 
properly  equipped  maternity  stable  serves  a  double  purpose. 
Owing  to  better  opportunity  for  handling,  it  protects  the 
animal  against  the  consequences  to  herself  of  any  infections 
which  she  may  bear  in  her  genital  organs,  and  it  guards 
against  the  contamination  of  premises,  food  or  water  by 
infectious  discharges.     As  a  rule  cows  at  the  termination 


696  Diseases  of  the  (ienilal  Organs 

of  pregnancy  have  genital  discharges.  After  abortion  in 
advanced  pregnancy,  and  after  calving  at  full  term,  asso- 
ciated with  retained  afterbirth  and  metritis,  the  discharges 
of  highly  virulent  pus  are  very  voluminous,  reaching  quarts 
and  even  gallons  daily.  If  such  cows  are  kept  in  stanchions 
in  the  milking  stable,  the  discharges  largely  drop  into  the 
gutter  and  go  out  with  the  manure.  However,  they  are  not 
wholly  disposed  of  in  this  safe  manner.  Portions  of  the 
discharges  reach  the  udder  of  the  affected  cow  or  various 
portions  of  her  body  and  of  the  bodies  of  adjacent  cows  and 
may  in  part,  as  dust  or  otherwise,  reach  the  milk,  or  the 
feed  and  water  of  the  cows.  It  is  yet  worse  when  the  af- 
fected animal  is  at  pasture  and  the  discharges  contaminate 
the  food  of  other  animals.  While  I  hold  it  has  not  been 
shown  that  the  eating  of  such  discharges  by  pregnant  cattle 
can  cause  interruption  of  the  existing  pregnancy,  I  regard 
it  nevertheless  as  unhealthy  and  not  without  peril.  I  con- 
sider it  of  far  greater  peril  to  a  young  calf  which  may  eat 
such  contaminated  food. 

The  maternity  stable  provides  greater  security  against 
errors  with  milk.  A  conscientious  dairyman  does  not  wish 
to  sell  milk  from  a  sick  cow,  but  when  such  an  animal  is  in 
the  dairy  stable  her  milk  is  liable  to  be  sent  to  market 
through  error.  Sometimes  drugs,  such  as  iodoform,  which 
taint  the  milk  repulsively  are  being  used  in  uterine  dis- 
eases, and  by  error  the  milk  is  included  with  that  of  the 
herd  and  is  sent  to  market.  This  would  generally  be  pre- 
vented by  the  use  of  an  adequate  maternity  stable.  The 
chief  purpose  served  by  such  a  stable  is  that  it  offers  the 
best  possible  facility  for  giving  to  a  puerperal  cow  that  at- 
tention which  will  most  safely  and  promptly  restore  her 
genital  health  if  diseased,  and  best  guard  it  if  well.  There 
is  no  time  in  the  life  of  a  cow  when  care  and  skill  can  ac- 
complish as  much  as  during  the  first  few  days  following 
the  termination  of  pregnancy. 


Systematic  Control  of  Genital  Infections  in  Herds  697 

C.  The  Systematic  Control  of  Genital  Infections  in  Herds. 
The  handling  of  each  phenomenon  occurring  in  the  course 
of  the  genital  infections  of  cattle,  including  the  congenital 
infections  of  calves,  each  independently  of  the  other,  is 
wasted  effort.  Science  and  economy  alike  demand  a  syste- 
matic effort  aimed  at  the  entire  complex  group,  each  effort 
having  a  definite  relationship  to  the  activities  in  combatting 
each  other  phenomenon  in  the  problem  as  a  whole. 

(1)  When  a  breeder  desires  to  improve  the  reproductive 
efficiency  of  his  herd,  it  is  essential  first  to  learn  definitely 
the  state  of  sexual  health  of  each  animal  of  breeding  age  of 
both  sexes.  The  bull  or  bulls  should  be  examined  in  detail, 
as  described  on  page  73,  and  under  "The  Genital  Infections 
of  Bulls".  If  the  bull  or  bulls  are  found  unfertile  or  of  low 
fertility,  they  should  be  temporarily  or  permanently  dis- 
carded. The  genital  organs  of  each  female  of  breeding  age 
should  be  examined  in  detail,  as  described  on  page  79,  and 
the  findings  recorded  approximately  as  suggested  on  page 
83. 

The  females  should  then  be  arranged  in  five  groups — 
pregnant,  probably  pregnant,  ready  to  breed,  under  treat- 
ment or  observation,  and  incurably  diseased.  The  second 
group  (probably  pregnant)  is  a  tentative  one  which  may  be 
eliminated  sixty  days  after  breeding,  when  pregnancy  can 
be  diagnosed  definitely.  The  incurably  diseased  should  be 
promptly  eliminated  from  the  herd.  The  handling  of  those 
under  treatment  should  be  vigorous  in  order  that  the  ani- 
mals may  be  shifted  to  the  group  which  is  ready  to  breed  as 
rapidly  as  expedient.  The  first  examination  having  been 
recorded  as  suggested  on  page  83,  each  subsequent  examina- 
tion should  be  recorded  as  indicated  in  Fig.  212,  and  each 
consecutive  record  attached  to  the  original.  Should  an  ani- 
mal fail  to  respond  to  the  measures  applied,  she  should  be 
shifted  at  the  earliest  date  of  certainty  to  the  incurable 
group  and  eliminated.  In  large  herds  of  purebred  beef 
cattle,  the  cows  and  heifers  should  not  only  be  classified  as 
suggested,  but  should  be  separated  into  four  separate  groups 
for  economic  handling,  these  groups  consisting  of  pregnant. 


698  Diseases  of  the  Genital  Organs 

ready  to  breed,  under  treatment,  and  weaned  heifers  too 
young  to  breed.  The  caretakers  then  have  their  work  sim- 
plified. The  pregnant  herd  requires  only  to  be  watched  for 
calvings  or  abortions.  Those  ready  to  breed  are  to  be  ob- 
served closely  for  estrum ;  when  heat  is  observed,  it  merely 
remains  to  determine  to  which  bull  she  is  to  be  bred.     Es- 

STERILITY-ABORTION 

RE-EXAMINATION 


Owner Address.- 

Date  of  last  examination Name  or  number  of   Animal. 

Record  of  estrum  and  service  since  last 


Character  of  estrum,  regular  or  irregular 

General  condition -.State  of  lactation.-- 

Right  broad  ligament Left  broad  ligament. 

Vulva Vagina 

Cervix Uterus 


Right  ovary  

Right  oviduct 

Left   ovary 

Left  oviduct - - 

Diagnosis Prognosis. 

Treatment  applied - 


Treatment  advised 
Remarks : 


Fig.  212.— Re-Examination  Records  for  the  Genital  Org-ans  of  Cows. 

(See  also  Fi)^.  37.  I 

trum  in  the  heifers  too  young  to  breed  and  in  cows  under 
treatment  is  of  no  direct  interest.  The  breeder  will  gener- 
ally profit  also  by  the  use  of  the  estrum  and  service  card 
suggested  in  Fig.  213.  These  filed  numerically  or  alphabeti- 
cally by  name  afford  a  helpful  index  in  breeding.  They  show 


Systematic  Control  of  Genital  bifedions  in  Herds  699 

at  a  glance  when  each  pregnant  cow  is  due  to  calve.  In 
non-pregnant  cows  not  yet  ready  to  breed,  the  duration  of 
time  since  last  calving  is  shown,  and,  in  cows  which  are  be- 
ing bred,  the  date  when  the  next  estrum  is  due,  giving  an 
opportunity  for  close  watch. 

(2)  When  pregnancy  terminates  (parturition  or  abor- 
tion), the  genital  health  of  the  animal  should  receive  atten- 
tion. The  uterus  should  be  examined  shortly  afterward.  If 
the  afterbirth  is  retained  or  the  animal  has  aborted,  handling 
should  begin  at  once.  If  parturition  has  been  apparently 
ESTRUM  AND  SERVICE  RECORD     HerdNo 


Name  of  Animal 

Dates  of  Estrum  <"  and  Service  for  year 

(1) 

i 

i 

i 

i 

>• 

5 

a 

± 

i 

j_ 

j_ 

Date  of  Service 

Bull  Used 

Menstruation  <}' 

Next  estrum  due 

Estimating  the  duration  of  pregnancy  at  280  days  animal  should  calve 
Pregnancy  from  above  service  terminated 

Di 


Abortion 
Result  i  Bull  Call 
Heifer  Calf 


I  In  herd  as  No. 
I  Died 
)  Sold 


■ach  calendar  year.     Where  breeding  c 


Fig.  213. 


-Estrum  and  Service  Index  Card  for  Keeping- 
Breeding  Records. 


normal,  the  examination  may  be  deferred  until  ten  to  twenty 
days  post  partum.  In  my  experience,  however,  I  find  large 
volumes  of  tarry  blood  with  a  flaccid,  much  enlarged  uterus 
at  three  to  four  days  post  partum,  and  this  regularly  ends 
in  a  mild  pyometra  not  recognizable  clinically  except  when 
the  uterus  is  examined  by  douching.  If  the  tarry  exudate  is 
recognized,  the  pyometra  can  be  anticipated  and  evaded.  In 
herds  where  metritis  and  retained  fetal  membranes  are  com- 
mon, it  is  preferable  to  assume  that  metritis  is  impending  in 
all  cows  and  to  introduce  capsules  of  iodoform  or  boric  acid 


700  Diseases  of  the  Genital  Orgajis 

and  bismuth  siibnitrate,  or  these  drugs  suspended  in  oil,  as 
a  rule  of  practice,  within  a  few  hours  after  the  termination 
of  pregnancy.  The  details  are  considered  under  "Puerperal 
Infections".  Re-examination  should  be  made  as  conditions 
may  suggest.  At  forty  to  sixty  days  after  calving  or  abort- 
ing, if  there  is  no  marked  disease,  an  examination  of  the 
genital  system  should  be  made  to  determine  if  the  patient  is 
ready  to  breed.  If  a  corpus  luteum  is  present  and  early 
breeding  is  desired,  the  corpus  luteum  may  be  dislodged  and 
estrum  induced.  Unless  there  is  reason  for  haste,  the  cor- 
pus luteum  should  be  left  undisturbed.  If  the  condition  of 
the  genital  organs  is  satisfactory,  she  may  then  be  bred. 

(3)  When  a  heifer  has  reached  the  age  to  breed,  or  when 
sufficient  time  has  expired  since  a  cow  has  calved  and  the 
genital  organs  are  healthy,  the  animal  may  be  bred.  The 
best  time  to  breed  a  cow  or  heifer  is  the  earliest  hour  in  es- 
trum when  she  will  stand  for  coitus  without  restraint.  The 
spermatozoa  will  then  have  ample  time  to  reach  the  pavilion 
of  the  oviduct  and  be  ready  to  fertilize  the  ovum  immediately 
it  is  discharged  from  the  ovary.  Prior  to  coitus  it  should  be 
seen  that  the  external  genitalia  of  the  female  are  clean.  It 
is  best  to  wash  the  vulva,  and  especially  to  free  the  vulvar 
tuft  of  hairs  from  dried  crusts  of  pus  which  may  be  caught 
by  the  penis  and  injure  it.  If  the  vagina  is  irritated  by  the 
nodular  venereal  disease  or  other  cause,  it  should  be  douched 
with  physiologic  salt  solution  or  0.25  per  cent.  Lugol's  solu- 
tion. The  copulatory  organs  of  the  bull  should  be  similarly 
cleansed  by  douching,  as  has  been  previously  described, 
special  attention  being  given  to  the  preputial  tuft  of  hairs. 
Coitus  may  then  occur  immediately.  Immediately  after 
coitus  the  copulatory  organs  of  the  bull  should  again  be 
douched. 

The  importance  of  washing  or  douching  the  copulatory 
organs  has  been  greatly  overestimated  by  many  and  under- 
estimated by  others.  The  douching  can  not  exert  any  direct 
influence  upon  deeply  seated  infections.  Its  value  is  strictly 
limited  to  superficial  infections  of  the  copulatory  organs.  It 
has  an  important  place  in  sox  hygiene.     Douching  prior  to 


Systematic  Control  of  Genital  Infections  in  Herds  701 

copulation  partly  eliminates  infections  lodged  in  these  areas 
and  tends  to  minimize  the  danger  of  infection  passing  by  sex 
contact  from  one  animal  to  the  other.  The  douching,  lessen- 
ing the  amount  of  infection  in  the  vagina  at  the  moment  of 
coitus,  lowers  the  danger  to  the  spermatozoa  during  their 
intra-vaginal  existence.  When  the  owner  of  the  bull  does  not 
know  the  record  of  a  strange  cow,  the  douching  immediately 
after  coitus  is  an  important  safety  measure,  but  a  good  bull 
should  not  be  permitted  to  copulate  with  a  cow  not  reason- 
ably known  to  be  sound. 

Vaginal  douching  immediately  after  coitus  is  not  compati- 
ble, so  far  as  known,  with  good  breeding  results.  It  would 
probably  prevent  conception  in  a  vast  majority  of  cases. 
Two  or  three  hours  after  coitus,  douching  of  the  vagina 
does  not  interfere  with  conception,  but  may  render  it  more 
secure.  The  spermatozoa  quickly  pass  into  and  through  the 
cervical  canal,  where  the  vaginal  douche  can  not  affect 
them.  The  douche  does,  however,  allay  the  vaginal  irrita- 
tion of  coitus,  especially  in  heifers  with  nodular  venereal 
disease  of  a  severe  type.  In  these  the  vaginitis  of  coitus  is 
very  marked,  but  may  be  quite  obviated  by  timely  douching 
with  0.25  per  cent,  Lugol's  solution.  Many  bulls  of  low  fer- 
tility ejaculate  bacteria  with  their  semen.  The  spermatozoa 
start  rapidly  upon  their  journey  and  probably  largely  leave 
behind  the  bacteria,  which  timely  douching  may  mechani- 
cally eliminate. 

The  highly  interesting  and  probably  very  valuable 
field  of  post-coital  uterine  douching  has  not  yet  been  ade- 
quately studied.  Cervicitis  is  one  of  the  commonest,  if  not 
the  commonest  lesion  in  the  genital  organs  of  the  cow,  and 
constitutes  a  formidable  menace  to  conception  and  preg- 
nancy. Copulation  increases  cervicitis  and  not  infrequently 
(streptococcic  semino-vesiculitis  of  the  bull,  etc.)  causes  cer- 
vicitis in  cows  which  were  healthy  up  to  the  time  of  coitus. 
Although  spermatozoa  frequently  pass  unharmed  over  the 
infected  cervical  mucosa,  at  this  time  deeply  submerged  be- 
neath the  flood  of  estrual  mucus,  if  conception  occurs,  the 
fertilized  ovum  upon  its  descent  into  the  uterus  is  exposed 


702 


Diseases  of  the  Genital  Organs 


immediately  to  the  bacteria  present.  The  uterine  douching 
may  partly  wash  the  infection  out  or  may  chemically  destroy 
it.  In  my  experience  post-coital  uterine  douching  often  re- 
veals muco-pus  in  the  cervix  or  cervical  end  of  the  uterus. 
The  healthy  vigorous  spermatozoa  have  probably  left  the 
uterus  and  ascended  the  oviducts  within  three  to  four  hours 
after  coitus.  From  that  time  until  the  fertilized  ovum  de- 
scends into  the  uterine  cavity,  uterine  douches  are  without 
peril  to  conception  and,  if  properly  done,  decrease  the  perils 
of  cervical  and  uterine  infections.  The  unknown  element  in 
this  field  is  the  minimum  duration  of  time  required  for  sper- 
matozoa to  pass  through  the  uterus  and  enter  the  oviduct, 
and  for  a  fertilized  ovum  to  traverse  the  oviducts  and  reach 
the  uterus.  I  have  stated  elsewhere  that  in  one  instance  I 
successfully  douched  muco-pus  from  the  uterus  of  a  preg- 
nant cow  thirteen  days  post  coitus.  It  is  reasonably  certain 
that  the  fertilized  ovum  was  not  in  the  uterus  at  that  time, 
but  it  is  not  certain,  and  I  believe  is  improbable,  that  the 
duration  of  time  in  this  instance  was  typical. 

The  number  of  copulations  which  a  bull  should  be  caused 
or  permitted  to  make  has  not  been  sufficiently  studied. 
There  are  certainly  very  wide  variations  in  individuals  in 
the  powers  of  sexual  endurance.  Some  breeders  have  at- 
tempted to  state  arbitrarily  the  number  of  cows  which  a  bull 
may  serve.  The  capacity  of  a  bull  should  be  based  upon  the 
number  of  copulations  it  may  be  prudent  to  have  him  make. 
The  number  of  cows  will  then  be  dependent  upon  the  fer- 
tility of  the  bull  and  the  average  fertility  of  the  individual 
cows  which  he  is  to  serve.  Reliable  data  of  the  average  rate 
of  conception  in  cattle  are  wanting,  and  most  persons  be- 
lieve the  conception  rate  to  be  far  above  the  facts.  In  one 
extensive  purebred  beef  herd,  where  both  bulls  and  cows 
were  grazed  throughout  the  year,  and  in  which  the  genital 
organs  were  exceptionally  healthy,  there  were  recorded 
2675  copulations,  with  1141  known  pregnancies,  resulting 
in  the  birth  of  1061  (39.66',  )  of  viable  calves,  46  (1.72',  ) 
non-viable  calves,  34  (1.31',,'  )  recorded  abortions,  and  1534 
(57.34'/  )    copulations  without  observed  result.    The   data 


Systematic  Control  of  Genital  Infections  in  Herds  703 

include  copulations  with  a  number  of  hopelessly  sterile 
cows,  as  well  as  a  number  of  copulations  by  a  sterile  bull. 
I  think  these  data  fairly  representative  of  the  more  fertile 
purebred  herds.  I  know  the  results  are  far  better  than  in 
some  herds.  The  timely  elimination  of  the  hopelessly  sterile 
cows  and  the  elimination  of  the  sterile  bull  would  have 
raised  the  efficiency  notably.  A  far  greater  advance  would 
have  been  made  by  taking  curably  infected  cows  out  of 
breeding  for  a  few  weeks  and  giving  them  proper  surgical 
attention.  As  the  data  stand,  they  furnish  some  helpful 
suggestions  regarding  the  number  of  cows  which  may  ordi- 
narily be  assigned  to  a  bull. 

Breeding  is  carried  on  by  two  separate  plans — massed  or 
seasonal  breeding  when  it  is  desired  to  have  all  calves  born 
during  a  limited  season,  and  perpetual  breeding  throughout, 
or  during  nine  or  ten  months  of  the  year.  A  bull  may  evi- 
dently make  with  safety  a  greater  number  of  copulations 
during  the  year  if  evenly  distributed  throughout,  and  can 
safely  make  a  greater  number  of  copulations  in  a  short  in- 
terval (one  week  or  one  month)  when  he  is  to  be  sexually 
idle  the  remainder  of  the  year.  Such  observations  as  I  have 
been  able  to  make  have  led  me  to  regard  an  average  of  two 
copulations  per  week  throughout  the  year  as  the  probable 
maximum  of  efficiency,  measured  by  the  percentage  of  preg- 
nancies, their  safety,  and  the  vigor  of  the  young.  Taking 
the  above  data  as  a  general  average  of  fertility,  a  healthy 
adult  bull  would  suffice  for  about  forty  cows  (100  copula- 
tions). 

When  the  breeding  is  massed,  the  frequency  of  coitus 
should  still  be  held  under  reasonable  control.  Probably  the 
frequency  of  coitus  may  be  advanced  to  four  or  five  times  a 
week  for  a  period  of  four  to  six  weeks.  Bulls  have  done 
more  than  this,  but  my  studies  indicate  that  usually  they 
undergo  a  gradual  decline  in  fertility  year  by  year  and  go 
down  so  far  that  they  do  not  eventually  regain  their  initial 
sex  vigor.  When  mass  breeding  is  undertaken  in  pasture, 
the  ratio  of  females  must  be  very  low,  especially  if  all  are 
ready  to  be  bred  when  the  bull  is  placed  with  them.    Under 


704  Diseases  of  the  Cicnital  Organs 

such  conditions  the  bull  may  copulate  several  times  with  a 
cow  during  one  estrum.  If  twenty-one  cows  are  assigned 
to  a  bull  and  each  has  an  estrual  cycle  of  twenty-one  days, 
there  will  be  an  average  of  one  cow  in  estrum  daily,  with 
the  inevitable  result  that  on  some  days  several  cows  will  be 
in  estrum.  The  number  of  cows  under  these  conditions 
should  therefore  be  below  twenty,  preferably  not  over  fif- 
teen. If  the  breeding  period  extends  over  ninety  or  more 
days,  more  cows  may  naturally  be  assigned  to  one  bull.  The 
breeding  of  ordinary  grade  beef  cattle  in  pasture  produces 
the  maximum  ratio  of  vigorous  calves,  if  the  bulls  are 
healthy  and  abundant,  but,  when  a  perilously  infected  bull 
is  used,  the  disaster  is  inevitably  as  great,  and  may  be 
greater  than  by  individual,  controlled  breeding.  The  ordi- 
r'^ry  grade  beef  cow  running  free  at  pasture  commonly  en- 
voys the  maximum  of  general  and  sexual  health,  but  it  is 
far  from  sufficient  to  withstand  the  shock  from  a  virulently 
infected  bull.  When  the  bull  consorts  constantly  with  the 
cows,  he  immediately  recognizes  estrum,  and  coitus  occurs 
promptly ;  in  controlled  breeding  estrum  is  frequently  too 
far  advanced  when  discovered  for  coitus  to  succeed.  Many 
estrual  periods  are  completely  overlooked.  If  observations 
are  made  but  once  daily,  a  cow  may  readily  come  in  estrum 
shortly  afterward  and  the  estrum  disappear  before  the 
next  search  is  made.  Indeed  the  healthiest  cows  have  the 
shortest  duration  of  estrum,  frequently  dropping  to,  or  be- 
low, fifteen  hours.  This  makes  it  essential  to  the  highest 
success  to  make  observations  for  estrum  at  intervals  of  about 
twelve  hours.  The  natural  inclination  of  some  breeders  to 
suspend  breeding  operations  on  Sunday  reduces  the  effi- 
ciency 14  per  cent.  If  the  estrual  cycle  in  the  individual  is 
other  than  twenty-one  days,  her  estrum  may  be  recognized 
at  its  next  appearance.  But  the  cycle  in  the  healthiest  cows 
is  most  frequently  twenty-one  days,  and,  once  in  estrum  on 
Sunday,  always  in  estrum  on  Sunday,  unless  the  estrual 
cycle  is  broken  by  pressing  the  corpus  luteum  from  the 
ovary. 

The  maximum  degree  of  safety  in  sex  hygiene  is  attained 


Systematic  Control  of  Genital  Infections  in  Herds  705 

by  the  permanent  mating  of  one  female  with  one  male. 
Whenever  polygamy  or  polyandry  is  substituted,  each  in- 
dividual in  the  group  becomes  exposed  through  sex  contact 
with  each  other  member  of  the  group.  Genital  infections 
increase  in  virulence  with  repeated  coitus.  The  larger  a 
group  of  apparently  sound  breeding  animals,  the  greater 
the  danger  that  some  one  of  the  group  harbors  a  highly  peril- 
ous infection.  In  practice  a  certain  group  of  cows  should 
be  assigned  to  a  given  bull  and  the  assignment  rigidly  main- 
tained. Nothing  can  well  be  more  imprudent  than  the  prac- 
tice of  shifting  a  sterile  cow  from  one  bull  to  another. 
I  have  records  where  the  breeder  had  used  five  or  six 
different  herd  bulls  on  one  cow  during  a  single  year.  Each 
of  the  bulls  thereby  exposes  the  cow  to  any  genital  infec- 
tions he  may  carry,  and  she  in  turn  exposes  each  subsequer 
bull  to  the  original  infections  in  her  own  organs  and  to  any 
which  may  have  been  deposited  therein  by  each  preceding 
bull.  It  is  sexual  pandemonium.  If  the  bull  and  the  cows 
assigned  to  him  are  rigidly  maintained  as  a  distinct  unit, 
the  breeder  soon  knows  of  the  fertility  of  the  bull.  If  he  is 
unfertile  the  remedy  is  clear.  If  nearly  all  cows  conceive 
promptly  and  one  is  sterile  after  repeated  coitus,  she  is  evi- 
dently at  fault  and  the  danger  from  her  should  be  eliminated 
promptly  by  overcoming  the  infection  or  by  sending  her  to 
slaughter.  There  is  a  false  assumption  that  some  cows  will 
not  conceive  to  one  bull,  but  may  do  so  to  another  of  equal 
fertility.  Bulls  show  every  gradation  of  fertility,  and  a 
cow  is  naturally  more  certain  to  conceive  to  the  bull  of 
highest  fertility,  but  the  bull  of  low  fertility  should  be 
eliminated  instead  of  used  unsuccessfully  upon  cows  and 
later  supplanting  him  with  a  highly  fertile  bull,  in  which 
case  the  latter  becomes  exposed  to  the  infections  deposited 
by  the  former. 

The  permanent  assignment  of  certain  cows  to  a  bull  may 
at  times  lead  to  the  complication  of  several  of  his  group 
coming  into  estrum  simultaneously  or  in  rapid  succession. 
This  need  cause  no  material  embarrassment.  The  rule 
should  be  made,  and  supported  vigorously,  restricting  the 

45 


■706  Diseases  of  the  Genital  Organs 

bull  to  one  coitus  per  day  and  only  rarely  permitting  coitus 
on  two  successive  days.  If  estrual  periods  become  massed, 
instead  of  imperilling  the  sexual  health  of  the  bull,  break 
the  estrual  cycle  in  one  or  more  animals  by  pressing  the 
corpus  luteum  from  the  ovary  three  to  five  days  before  it  is 
desired  to  have  her  come  in  estrum. 

The  importance  of  maintaining  the  general  vigor  of  breed- 
ing animals  has  already  been  mentioned,  but  it  may  be  well 
to  emphasize  some  special  points.  Bulls  are  largely  kept  too 
closely  housed  and  far  too  highly  fed.  The  bull  needs  abun- 
dant physical  exercise,  and  should  either  be  given  daily 
work  (which  is  the  most  economic  and  best  method  for  re- 
taining physical  vigor)  or  provided  with  an  extensive  pad- 
dock where  he  can  come  and  go  at  will  and  have  abundant 
exercise. 

The  feeding  of  purebred  dairy  cattle  for  high  milk  and 
butter  yield  is  one  of  the  most  complex  and  delicate  opera- 
tions in  animal  husbandry.  Many  breeders  are  record-mad 
and  crowd  cows  beyond  their  powers  of  endurance.  Many 
world-famous  cows  never  breed  after  making  a  phenome- 
nal record.  The  breeder  is  left  with  a  cow  which  holds  the 
record  in  her  class  for  milk  or  butter  and  is  incapable  of 
yielding  any  of  either.  Nymphomania  closes  the  breeding 
career  of  so  many  high-record  cows  that  the  suspicion  may 
well  be  aroused  that  some  of  these  performances  are  actu- 
ally pathologic,  and  that  the  great  yield  of  butter  fat  is 
really  the  consequence  of  unseen  changes  going  on  in  her 
ovaries,  which  later  culminate  in  the  obvious  cystic  ovarian 
disease.  The  destruction  of  the  reproductive  powers  of  a 
great  cow  by  imprudent  handling  in  an  effort  to  advance 
her  record  is  a  crime  against  the  state.  The  breeder  has  no 
greater  right  to  ruin  a  highly  valuable  cow  than  he  has  to 
burn  or  otherwise  destroy  a  valuable  house  which  ho  le- 
gally owns. 

Analogous  conditions  prevail  among  breeders  of  beef  cat- 
tle, who,  at  great  peril  to  the  reproductive  powers  of  their 
animals,  feed  them  inordinately  for  show.  It  is  notorious 
that  cattle  which  are  extensively  exhibited  largely  become 


Systematic  Control  of  GeJiital  bifectiojis  in  Herds  707 

sterile.  Males  and  females  sometimes  win  the  highest  prizes 
in  breeding  or  in  dairying  classes  when  they  are  hopelessly 
sterile  or  are  dry  and  will  never  again  yield  milk.  Much  of 
the  harm  now  being  done  could  be  overcome  by  the  breed- 
ers' associations  and  fair  managers  by  offering  prizes  for 
fertility  in  individuals  and  in  herds,  and  by  basing  all  milk 
and  butter  records  and  all  prizes  at  fairs  upon  high  stand- 
ards of  fertility.  If  an  animal  is  shown  as  a  purebred  for 
breeding  purposes,  let  its  fertility  be  proven  beyond  doubt. 
If  a  cow  is  shown  in  the  dairying  classes,  let  it  be  proven 
that  she  is  capable  of  yielding  milk  and  butter. 

The  most  regrettable  feature  in  the  imprudent  destruc- 
tion of  the  breeding  powers  of  cattle  is  the  fact  that  the 
ruined  animals  represent  the  best  individuals  of  their  re- 
spective breeds  and  should  by  every  scientific  and  moral 
consideration  be  retained  as  efficient  progenitors  of  their 
excellent  qualities.  Instead,  when  cattle  achieve  renown, 
they  are  ruined  by  a  false  ambition  to  push  them  one  more 
point.  Then  the  breeder  must  step  downward  and  back- 
ward, begin  again  with  ordinary  individuals,  and  labori- 
ously produce  another  illustrious  family,  which  he  may 
wreck  upon  the  same  shoal. 

The  handling  of  the  genital  infections  of  cattle  by  means 
of  biologic  products  has  been  discussed  at  some  length  under 
abortion  and  conyemiol  diseases  of  calves.  Nothing  could 
be  more  earnestly  desired  than  a  convenient  specific  for  this 
destructive  group  of  infections,  but  thus  far  no  notable  suc- 
cess has  been  achieved,  unless  calf  scours  serum  is  excepted. 
In  this  instance  the  question  has  been  raised  whether  the 
success  may  not  be  due  to  the  plain  serum  rather  than  to  the 
changes  brought  about  by  the  bacterial  inoculations  of  the 
horse.  At  present  the  outlook  for  great  victories  with  "bi- 
ologies" is  not  hopeful  and  the  representations  made  by  ven- 
dors of  abortion  serums,  bacterins,  and  vaccines  are  not 
warranted  by  any  recorded  facts. 

Some  who  believe  in  "contagious  abortion"  as  a  specific 
disease,  like  tuberculosis  or  hog  cholera,  advise  the  enact- 
ment  of   statutory   laws   placing   these   general   infections 


7o8  Diseases  of  the  Gc7iital  Orga?is 

among  the  specific  diseases  subject  to  obligatory  report  to 
the  state  veterinarian  or  other  official,  who  would  quaran- 
tine and  otherwise  restrict  the  movement  of  the  diseased  or 
suspected  cattle.  Indeed  such  laws  already  exist  in  some 
states  but  so  far  as  I  have  learned  the  statutes  do  not  clearly 
define  "contagious  abortion",  but  leave  the  definition  to  the 
attending  veterinarian  or  the  breeder.  As  a  result  the  stat- 
utes and  the  disease  have  not  come  in  conflict.  Thus  far  it 
has  been  impossible  to  define  "contagious  abortion"  in  such 
a  way  as  to  render  a  law  regarding  it  workable.  If  it  is 
defined  as  the  presence  of  the  B.  abortus  in  the  bodies  of 
cattle,  its  presence  in  the  milk  of  a  large  percentage  of 
dairy  cows  would  render  the  application  of  such  a  law  im- 
possible without  prostrating  the  dairy  industry.  Even  then 
the  B.  abortus  would  still  flourish  in  other  animals.  If  a 
law  is  to  be  made  which  will  apply  only  to  the  B.  abortus 
in  the  uterus,  it  is  the  common  view  that  it  persists  in  the 
uterine  cavity  only  for  a  few  weeks  after  the  termination  of 
pregnancy,  and  quarantine  for  those  few  weeks  could  not 
and  would  not  favorably  aff"ect  the  reproductive  powers  of 
the  animal.  The  chief  objection  to  legal  restrictions  is  that, 
if  the  report  of  abortion  be  made  compulsory,  the  breeder 
can  not  afford  to  call  the  veterinarian,  since  his  attendance 
and  report  mean  quarantine  with  financial  loss  or  ruin, 
while  the  restrictions  placed  upon  the  herd  are  absolutely 
impotent  to  better  conditions. 

D.  The  Genital  Infections  of  Cattle  as  an  Economic  Problem. 

No  infection  or  group  of  infections  of  domestic  animals 
offers  at  present  a  more  serious  or  pressing  economic  prob- 
lem. The  infections  are  essentially  omnipresent  and  im- 
peril life  and  fertility  at  every  step.  The  spermatozoa  and 
ova  must  run  a  gauntlet  of  threatening  infection  before  fer- 
tilization may  occur.  The  fertilized  egg  has  its  perils  as  it 
passes  through  the  oviducts,  and  throughout  pregnancy  the 
peril  of  infection  both  to  the  intra-uterine  young  and  to  the 
mother  never  ceases.  The  danger  does  not  end  with  par- 
turition but  the  infection,  persisting  in  both  the  mother  and 


Genital  Infections  of  Cattle  as  an  Economic  Problem         709 

the  young,  continues  its  destruction.  The  United  States  De- 
partment of  Agriculture  has  made  the  estimate  that  the 
phenomenon  of  abortion  costs  the  nation  twenty  million 
dollars  annually.  The  dairy  cow,  in  order  to  yield  the  maxi- 
mum amount  and  quality  of  milk,  should  give  birth  to  one 
healthy  calf  each  twelve  months.  The  purebred  herds  drop 
to  between  50  and  75  per  cent,  of  this  ideal  during  an  ap- 
pallingly brief  breeding  career.  Including  all  cattle  of 
dairy  breeds,  the  reproductive  efficiency  does  not  exceed  one 
calf  in  each  fourteen  months,  so  that  each  cow  is  kept  upon 
an  average  two  functionless  months.  If  the  loss  is  rated  at 
five  dollars  per  cow  per  month,  the  1,500,000  cows  in  the 
State  of  New  York  alone  aggregate  an  annual  loss,  due  to 
delay  in  conception,  of  $15,000,000.  That  is  but  one  item  of 
loss.  When  the  total  losses  are  considered,  the  sum  is  many 
times  the  one  item  noted,  making  this  easily  the  most  de- 
structive group  of  infections  of  cattle.  The  statement  is 
now  and  then  made  that,  next  to  tuberculosis,  "contagious 
abortion"  is  the  most  destructive  disease  of  cattle.  That  con- 
clusion is  based,  if  not  wholly,  at  least  chiefly,  upon  the  ob- 
served expulsion  of  the  fetal  cadaver  and  technically  re- 
stricted to  the  damage  alleged  to  be  inflicted  by  B.  abortus. 

E.  The  Genital  Infections  of  Cattle  in  Their 
Relation  to  Human  Health. 

Milk  and  its  derivatives  constitute  the  most  important 
food  of  the  human  race.  Milk  has  been  clearly  shown  to  be 
a  dangerous  carrier  of  infections,  such  as  scarlatina,  ty- 
phoid fever,  putrid  sore  throat,  and  others.  These  are 
largely  contaminations  occurring  outside  the  udder.  After 
Koch  had  discovered  the  tubercle  bacillus  and  thought  bo- 
vine and  human  tuberculosis  identical,  it  was  believed  for 
some  years  that  much  human  tuberculosis  was  due  directly 
to  the  use  of  milk  from  tubercular  cows.  Later  researches 
have  modified  that  view,  and,  while  still  considered  as  of 
essential  importance  to  human  health,  bovine  tuberculosis 
is  not  thought  to  be  as  perilous  for  man  as  it  was  at  an 
earlier  date.    More  recently,  following  the  discovery  of  the 


yio  Diseases  of  (he  Genital  Organs 

B.  abortus  and  the  assignment  to  it  of  specific  abortifacient 
powers,  the  question  arose  regarding  the  possibility  of  the 
infection  invading  pregnant  women  and  causing  abortion. 
A  few  inconclusive  observations  were  recorded.  Occasion- 
ally the  blood  of  men  and  women  agglutinates  the  B.  abortus, 
but  no  extended  study  of  the  prevalence  of  the  organism  in 
the  human  body  has  been  attempted.  Natural  infection 
with  B.  abortus  has  been  recorded  in  swine  and  guinea  pigs, 
and  experimental  infection  in  all  domestic  mammals.  It 
would  not  be  surprising,  therefore,  if  a  thorough  search 
showed  the  B.  abortus  to  be  a  very  common  resident  of  the 
human  body  without  striking  evidence  of  peril  to  health. 
The  general  infections  of  the  genital  tracts  of  cattle,  which 
cause  such  an  appalling  amount  of  disease,  not  only  in 
adults,  but  in  fertilized  ova,  the  embryo,  the  fetus  and  the 
calf,  probably  offer  at  this  time  one  of  the  most  valuable 
fields  for  the  study  of  animal  diseases  in  connection 
with  human  health.  There  has  been  much  inconclusive 
argument  regarding  the  virtues  and  vices  of  raw  and 
cooked,  clean  and  dirty,  rich  and  poor  milk  as  a  health- 
ful food  for  man,  especially  for  children  and  for  the 
infirm.  It  has  appeared  to  me  unfortunate  that  the 
primary  study  of  the  effect  of  feeding  milk  to  the 
young  has  been  carried  out  chiefly  upon  children.  There  has 
been  built  up  a  system  of  dairy  inspection  based  upon  cer- 
tain theoretical  considerations  of  the  outside  of  the  prob- 
lem. If  that  is  properly  gilded,  the  deeper  facts  are  ignored. 
One  often  sees  ''certified"  milk  being  sold  at  an  advanced 
price  as  food  for  children,  while  the  calves  in  the  dairy,  to 
which  part  of  the  same  milk  is  being  fed,  are  sick  and  dying. 
So  our  dairy  inspection  maintains  in  effect  that  milk  which 
is  perilously  toxic  for  calves  is  "certifiable"  for  infants. 

The  anatomic  position  of  the  mammae  of  the  cow  justifies 
the  general  assertion  that  the  milk  contains  some  parts  of 
any  genital  discharges  which  are  occurring.  Hygienically 
this  contamination  is  theoretically  re(Uiced  to  the  minimum 
through  the  formal  rules  for  the  production  of  "certified" 
milk.  In  the  average  dairy,  sixty  per  cent,  of  the  cows,  if 
examined  five  days  after  calving,  have  two  or  thi-e(>  ounces 


Genital  Infections  of  Cattle  iji  Relation  to  Hnman  Health       7  1 1 

to  as  many  pints  of  tarry  blood  or  of  pus  in  the  vagina  or 
uterus.  The  uterus,  which  should  at  this  time  be  firmly  con- 
tracted and  so  involuted  that  it  may  be  picked  up  per  rectum 
and  held  in  the  hollow  of  the  hand,  is  instead  a  great  flaccid 
organ,  hemorrhagic  and  paretic.  There  is  inevitably  a  dis- 
charge, but  this  is  so  common  that  dairymen  and  dairy  in- 
spectors call  it  "normal".  Portions  of  these  disease  excre- 
tions flow  down  the  tail  and  thighs,  and  upon  the  udder  and 
teats.  The  ordinary  washing  of  the  udder,  as  practiced  in 
certified  dairies,  does  not  assure  the  exclusion  of  such  in- 
fections from  the  milk.  This  is  sharply  emphasized  by  the 
clinical  fact  that  mammary  infection  during  the  puerperal 
period  is  commonest  in  the  posterior  quarters  of  the  udder, 
which  are  most  exposed  to  genital  discharges,  and  that,  the 
more  intense  the  genital  infection  (e.  g.  retained  fetal  mem- 
branes), the  more  probable  is  mammary  infection.  So  far 
as  I  am  aware,  no  technical  study  has  been  made  of  the  bac- 
teriology of  intra-mammary  milk  from  cows  with  intense 
genital  infection  in  comparison  with  milk  from  cows  with 
typically  healthy  genitalia.  It  is  logical  to  assume,  until  we 
have  more  definite  knowledge,  that  intra-mammary  milk 
contains  as  a  rule  more  bacteria  in  a  cow  with  severe  genital 
infection  than  in  one  which  is  healthy.  By  any  practical 
method  of  milking  there  is  inevitably  added  a  variable  pro- 
portion of  the  genital  discharges  which  adhere  to  the  exte- 
rior of  the  udder  and  adjacent  regions.  The  inevitable  bac- 
terial contamination  of  milk  from  genital  discharges  is  not 
confined  to  the  puerperal  period.  I  have  evacuated  quarts 
and  gallons  of  fetid  pus  from  the  uteri  of  cows  in  certified 
dairies,  when  the  history  indicated  undeniably  that  the  ex- 
cessively fetid  pyometra  had  existed  for  more  than  a  year 
and  the  cows  had  been  repeatedly  inspected  and  passed  by 
the  dairy  inspectors  representing  great  cities.  Much  of  the 
present  "skin-deep"  dairy  inspection  is  a  farce,  the  price  of 
which,  in  human  health,  can  not  be  accurately  computed. 

The  entire  field  of  the  genital  diseases  of  cattle  offers  a 
priceless  opportunity  for  the  study  and  advancement  of  hu- 
man health.   The  genitalia  of  cattle  offer  the  most  available 


7 1 2  Diseases  of  the  Genital  Organs 

field  for  the  clinical  study  of  the  basic  phenomena  of  ovula- 
tion, menstruation  and  fertilization.  Slaughtered  cattle  of 
the  abattoir  furnish  inexhaustible  material  for  studying  the 
bacteriolog\'  and  pathology  of  the  genitalia  of  both  non- 
pregnant and  pregnant  animals.  The  fetal  membranes  af- 
ford unsurpassed  opportunity  for  the  study  of  bacterial  in- 
vasion of  the  embryonic  sac.  Within  the  alimentary  tract 
of  the  fetus,  as  a  constituent  of  the  meconium,  is  stored  up, 
alive  though  frequently  inert,  bacteria  the  presence  of  which 
affords  a  reliable  history  of  the  bacteriology  of  the  pregnant 
uterus  and  a  suggestive  prophecy  of  the  pathologic  changes 
which  may  follow  birth.  The  new-born  dairy  calf,  fed  as  it 
is  by  artificial  means  and  upon  the  milk  of  dairy  cows,  of- 
fers by  far  the  greatest  and  most  reliable  source  for  an  ex- 
perimental study  of  the  feeding  of  milk  to  the  new-born. 
The  influence  of  pasteurization  and  sterilization  of  milk  be- 
fore feeding,  and  the  relation  of  bacteria  borne  in  milk  and 
of  bacteria  existing  in  the  meconium  of  the  new-born  to  each 
other  and  to  the  health  of  the  calf,  are  comprehensive  prin- 
ciples not  restricted  to  the  species  of  animal.  The  bacteria 
commonly  resident  in  the  meconium  of  the  new-born  calf, 
can  probably  be  transferred  to  the  digestive  tube  of  children 
and  cause  in  them  perilous  disease. 


SECTION  II.     THE  GENITAL  INFECTIONS  OF 
SHEEP  AND  GOATS 

CHAPTER  XV 

SPECIFIC  VENEREAL  DISEASES 

The  Nodular  Venereal  Disease 

While  describing  the  nodular  venereal  disease  of  cattle,  it 
was  stated  that  the  same  infection  is  commonly  present  in 
the  copulatory  organs  of  both  sexes  of  sheep  and  presumably 
also  of  goats.  According  to  my  observations  the  infection 
is  not  as  severe  in  sheep  as  in  cattle,  probably  because  the 
sex  and  maternal  relations  are  of  a  simpler  character.  So 
far  as  I  have  observed,  the  disease  has  little  if  any  economic 
importance  in  sheep.  Any  extended  consideration  would  be 
essentially  a  repetition  of  what  has  already  been  said  of  the 
disease  in  cattle. 


CHAPTER  XVI 


NON- VENEREAL  INFECTIONS  WHICH  INVADE 
THE  GENITAL  ORGANS 

Necrotic  Disease  of  the  Genital  Organs  Associated 
With  Lip-and-Leg  Ulceration 

Flook  (Jour.  Comp.  Path,  and  Therap.,  Vol.  XVI,  p.  374) 
records  an  outbreak  of  a  venereal  disease  among  sheep.  He 
relates  that,  in  a  herd  of  fifty-two  yearling  ewes  and  two  ram 
lambs  which  had  been  recently  purchased,  it  was  noted  that 
one  of  the  rams  had  a  discharge  from  the  sheath,  while  the 
other  had  extensive  eruptions  about  the  mouth  and  nose. 
Nothing  was  seen  amiss  with  the  ewes.  Afterward  the  two 
rams  were  taken  from  the  band  with  which  they  had  been 
purchased  and  placed  with  a  small  flock  of  old  ewes.     After 


714 


Diseases  of  the  Genital  Orgajis 


one  week  Flook  found  nine  of  the  old  ewes  showing  great 
swelling  of  the  vulvae  with  raw,  bleeding  sores  upon  the 
mucous  and  cutaneous  surfaces  of  the  vulvar  lips.  An  ex- 
amination of  the  rams  revealed  ulcerating  sores  in  the  sheath 
of  one  and  eruptions  upon  the  upper  lip  of  the  other.  Ap- 
parently the  general  health  of  the  animals  was  not  dis- 
turbed. 

The  rams  had  been  marked  with  color  upon  the  breasts 
between  the  forelegs,  so  that  each  ewe  which  was  served 
could  be  identified.  By  this  means  it  seemed  to  be  de- 
termined that  two  had  contracted  the  disease  without  coition. 
Flook  suggests  that  the  disease  may  have  been  transmitted 
by  the  ram  which  had  the  eruptions  on  his  upper  lip,  through 
smelling  of  the  vulvae  of  these  two  animals,  or  that  it  might 
have  been  caused  by  flies  bearing  the  disease  from  one  ani- 
mal to  another,  since  the  affection  appeared  during  the 
month  of  August.  The  affected  ewes  were  isolated  and  the 
sores  dressed  with  antiseptics.  Gradually  they  all  re- 
covered. 

On  the  following  page  of  the  same  journal.  Sir  John  Mc- 
Fadyean  contributes  observations  made  by  himself  upon  an 
outbreak  which  he  considers  identical  with  that  described 
by  Flook.  He  saw  twelve  ewes  affected  in  one  flock,  showing 
intense  inflammation,  swelling  and  tenderness  of  the  vulva. 
The  vulvar  musosa  was  inflamed  and  some  ulcers  were  pres- 
ent both  on  the  mucous  membrane  and  the  skin.  There 
was  a  slight  purulent  discharge  from  the  vulva.  As  these 
ewes  had  been  served  by  a  hired  ram  which  had  been  re- 
turned to  his  owner  six  days  previously,  McFadyean  failed 
to  see  the  animal.  McFadyean  attempted  to  produce  the 
disease  experimentally  by  collecting  the  discharges  upon 
pledgets  of  cotton,  one  of  which  was  introduced  into  the 
vulva  of  a  ewe,  another  into  that  of  a  cow.  and  a  third  into 
the  sheath  of  a  wether. 

Though  two  of  these  experiments  proved  negative,  a  swell- 
ing of  the  sheath  was  apparent  in  the  wether  two  days  after 
the  inoculation.  This  was  still  further  increased  on  the 
fourth  day  and  accompanied  by  a  slight   discharge.     The 


Necrotic  Disease  of  the  Genital  Organs  715 

swelling  at  this  time  was  sufficient  to  make  the  exposure  of 
the  penis  impossible.  The  symptoms  continued  over  a  pe- 
riod of  about  two  weeks.  On  the  third  day  there  appeared 
on  the  skin  near  the  opening  of  the  sheath  a  small  sore  which 
was  covered  with  a  brownish  scab.  This  sore  continued  to 
spread  around  the  opening  of  the  sheath.  On  the  fifteenth 
day  after  inoculation,  two  small  abscesses  had  formed  on 
the  prepuce  near  the  primary  sore ;  these  ruptured  the  next 
day,  leaving  shallow  ulcers.  At  this  time  a  third  small 
abscess  had  formed.  All  the  ulcers  were  covered  later  with 
brownish  crusts,  after  which  they  began  to  heal.  Attempts 
to  transfer  the  disease  artifically  from  this  animal  to  an- 
other wether  and  ewe  failed.  McFadyean  did  not  succeed 
in  isolating  any  organism  which  he  believed  to  be  the  cause. 
While  both  outbreaks  here  mentioned  have  been  compara- 
tively mild  in  their  course,  McFadyean  remarks  that  the 
disease  deserves  careful  observation  and  that  newly  pur- 
chased rams  might  well  be  examined  with  reference  to  this 
affection  before  being  used  for  breeding. 

G.  H.  Williams  (Vet.  Jour.,  Vol.  XVII,  p.  64)  records  two 
outbreaks  of  this  disease.  In  his  first,  in  a  flock  of  eight 
ewes  and  one  ram,  two  ewes  and  the  ram  were  affected. 
There  was  balanitis  and  ulceration  of  the  penis.  He  ap- 
plied to  the  parts  chinosol  and  zinc  sulphate  in  solution. 
The  animals  recovered  in  about  two  weeks.  In  his  second 
outbreak,  three  rams  and  forty  ewes,  in  a  flock  of  fifty, 
showed  the  symptoms  described  by  Flook  and  McFadyean. 
In  one  ewe  eruptions  occurred  upon  the  nostril.  In  some 
of  his  cases,  the  vulva  was  greatly  swollen  and  distorted; 
in  others  there  were  extensive  granulations  of  a  dark  color 
which  protruded  out  through  the  vulva.  The  granulations 
and  ulcers  were  penciled  with  silver  nitrate  and  the  entire 
parts  washed  with  a  solution  of  zinc  sulphate  and  chinosol. 

In  another  flock  of  ewes,  which  had  not  associated  with 
this  one,  except  that  one  of  the  rams  had  been  with  them, 
it  was  found  that  twelve  had  eruptions  about  the  lips  and 
noses  but  no  genital  affection  was  present.  A  second  ram 
in  this  lot  escaped  the  disease,  so  far  as  seen.     In  the  larger 


7i6  Diseases  of  the  Genital  Orga)is 

flock  of  ewes,  the  rams  were  isolated  and  the  affected  ewes 
removed  immediately  from  the  herd.  Daily  inspection  was 
made  of  the  apparently  well  ewes  and  any  which  developed 
the  symptoms  of  the  disease  were  promptly  separated.  A 
few  weeks  later  breeding  was  resumed  without  recurrence 
of  the  disease,  and  in  due  time  the  ewes  dropped  healthy 
lambs. 

About  1909  an  affection  not  distinguishable  from  that  ob- 
served by  Flook,  McFadyean  and  others  in  England  be- 
came widely  prevalent  and  caused  quite  serious  losses  in 
condition  and  wool  yield  upon  the  extensive  sheep  ranges 
of  the  Rocky  Mountains.  It  was  attributed  by  Mohler  and 
others  to  B.  necrophorus.  It  was  known  generally  as  lip- 
and-leg  ulceration  and  was  characterized  chiefly  by  the  for- 
mation of  necrotic  patches  about  the  feet  and  lips.  Whe-) 
breeding  was  attempted,  the  genitalia  became  severely  in- 
volved. The  mortality  was  low,  but  there  was  important 
loss  of  condition.  I  saw  one  flock  of  Western  sheep  which 
were  quite  generally  involved  after  their  arrival  in  the  East. 
Being  feeders,  thus  excluding  coitus,  the  necrosis  was  vir- 
tually limited  to  the  feet  and  lips. 

The  disease  is  apparently  easily  controlled  by  isolation 
of  the  affected,  with  disinfection  of  the  necrotic  areas. 
Cauterization  of  the  ulcers  with  solid  silver  nitrate  appears 
especially  efficacious.  When  the  disease  is  present  during 
the  breeding  season,  breeding  should  be  promptly  suspend- 
ed until  the  infection  has  been  brought  under  control. 


CHAPTER  XVII 

THE  GENERAL  INFECTIONS  OF  THE  GENITALIA 
OF  SHEEP  AND  GOATS 

The  general  infections  invading  the  genitalia  of  sheep 
have  received  no  adequate  study  and  veterinary  literature  is, 
as  a  consequence,  essentially  barren  of  any  comprehensive 
information.  The  breeding  value  of  an  individual  sheep  is 
ordinarily  not  great  and  the  attainable  salvage  by  selling  a 
sterile  animal  for  mutton  leaves  an  unimportant  margin  of 
loss.  Consequently  ewes  which  fail  to  produce  young  are 
ordinarily  sent  to  slaughter  without  comment.  While  in 
small  flocks  of  large,  well-nourished  sheep,  there  may  be 
at  times  a  reproductive  ratio  of  200  per  cent.,  this  is  not 
reached  in  large  flocks ;  in  the  smaller  breeds  the  ratio  falls 
below  100  per  cent.  The  increase  frequently  drops  to  75 
or  80  per  cent,  or  even  less  without  causing  comment.  Fre- 
quently also  ewes  are  not  bred  often,  but  only  for  two  or 
three  years,  when  the  matured  animals  are  sent  to  market 
and  are  replaced  by  ewe  lambs. 

The  rest  periods  between  births  are  long,  giving  ample 
time  for  the  recovery  of  the  health  of  the  genitalia.  Sheep 
are  ordinarily  bred  during  a  very  limited  season,  the  dura- 
tion of  pregnancy  is  short,  and  both  sexes  quickly  attain 
rest.  The  new-born  lamb  grows  usually  under  exceptional- 
ly hygienic  surroundings.  Born  as  a  rule  in  temperate 
weather,  it  is  constantly  on  pasture  and  nurses  its  mother. 
Thus  it  escapes  the  filthy  housing  so  often  forced  upon  calves 
and  is  spared  the  mixed  milk  containing  an  abundance  of 
various  bacteria,  to  which  is  commonly  added  infection  from 
dirty  feeding  pails  and  other  sources.  Accordingly  lambs 
largely  escape  the  digestive  perils  to  which  calves  are  sub- 
jected, and  as  a  consequence  grow  to  sex  maturity  with 
cleaner  genital  organs.  Hence  they  show  higher  fertility 
in  the  first  breeding  season.  Regardless  of  these  advan- 
tages in  environment  and  the  plan  of  breeding,  the  infec- 
tions of  the  genitalia  sometimes  acquire  such  virulence  as  to 


7i8  Diseases  of  the  Gejiital  Organs 

cause  serious  and  notable  economic  loss.  As  in  cattle  and 
other  mammalia,  the  storms  of  infection  attract  the  atten- 
tion, though  if  the  question  is  carefully  studied,  there  is 
seen  to  be  far  greater  loss  in  the  aggregate  constantly  oc- 
curring in  one  individual  after  another.  One  ewe  expels 
unseen  a  small  fetus  or  embryo ;  another  expels  at  full  term 
a  cadaver  which  has  just  died ;  another  gives  birth  to  a  weak 
lamb  which  succumbs  to  septicemia,  dysentery  or  arthritis, 
or  the  ewe  has  retained  fetal  membranes.  These  are  passed 
over  as  "accidents"  in  the  path  of  reproduction  and  the 
breeder  fails  to  measure  the  endless  economic  leak  which  is 
occurring  in  his  herd  and  which  is  very  important  if  once 
placed  in  correct  view.  When  the  infection  attains  high 
virulence  and  a  storm  breaks,  the  breeder  takes  alarm,  al- 
though perhaps  the  same  infection  has  long  been  at  work 
in  his  herd,  causing  important  losses  while  gathering  mo- 
mentum to  break  finally  with  fury. 

As  in  cattle,  so  in  sheep,  the  most  striking  result  of  genital 
infection  is  the  observed  expulsion  of  a  fetal  cadaver — abor- 
tion. In  the  earlier  stages  of  pregnancy  the  expulsion  of  a 
fetal  cadaver  is  not  readily  recognized.  The  embryo  is 
very  small  compared  to  the  bovine  embryo,  and  retained 
chorion  and  amnion  is  not  common,  but  the  fetal  placentae 
break  away  from  the  chorion  and  are  often  retained  within 
the  cotyledonal  chalice  of  the  uterus.  The  wool  obscures  the 
vulva  and  any  moderate  soiling  of  it.  When  a  large  fetal 
cadaver  is  expelled,  it  is  apt  to  be  observed  and,  if  evidently 
immature,  is  characterized  as  abortion;  if  expelled  at  ap- 
proximately full  term,  it  is  regarded  merely  as  "a  dead  lamb" 
without  significance.  If  the  observed  expulsions  of  fetal 
cadavers  become  numerous  as  a  result  of  the  same  infec- 
tions, "contagious  abortion"  is  diagnosed. 

The  diseases  of  the  testes,  epididymes,  and  glands  about 
the  pelvic  urethra  of  the  ram  have  not  been  studied.  The 
same  is  true  of  the  ovaries  and  oviducts  of  the  ewe.  The 
principal  attention  has  been  paid  to  the  changes  going  on 
within  the  uterine  cavity  resulting  in  the  death  and  expul- 
sion of  the  fetus. 


General  Infections  of  the  Genitalia  of  Sheep  and  Goats      7 1 9 

The  infections  which  may  cause  abortion  are  undeter- 
mined and  probably  quite  varied.  The  B.  abortus  is  capable 
of  multiplying  within  the  uterine  cavity,  as  has  been  demon- 
strated abundantly  by  various  investigators.  The  experi- 
mental inoculations  have  not  shown,  however,  that  it  does 
or  can  with  any  certainty  cause  a  pregnant  ewe  to  abort, 
although  some  conclude  that,  if  the  B.  abortus  is  present,  it 
can  cause  abortion.     It  is  a  difficult  matter  to  prove. 

The  organism  most  frequently  alleged  to  be  the  cause,  or 
the  most  common  cause,  of  abortion  in  the  ewe  is  a  vibrio  or 
spirillum  apparently  identical  with  the  vibrio  previously  de- 
scribed as  associated  with  certain  outbreaks  of  cattle  abor- 
tion. The  belief  that  the  spirillum  causes  the  abortion  in 
those  cases  where  it  is  recognized  is  based  fundamentally 
upon  its  recognition  in  abundance  in  the  stomach  of  the  fetal 
cadaver.     This  constitutes  valuable  presumptive  evidence. 

McFadyean  and  Stockman^  have  given  the  vibrio  the 
most  extended  study  yet  published.  The  organism  is  S- 
shaped  or  spiral,  1.5  to  3  microns  in  length.  It  grows  in 
various  culture  media.  The  colonies  present  an  appearance 
like  B.  abortus.  The  living  organisms  are  highly  motile, 
moving  rapidly  in  a  spiral.  McFadyean  and  Stockman  be- 
lieved they  had  proven  by  experimental  inoculation  that  the 
vibrio  they  described  caused  the  abortions.  In  many  cases 
of  abortion  following  natural  exposure,  the  vibrio  could  not 
be  found.  In  some  cases  putrefactive  bacteria  may  have 
destroyed  or  veiled  the  vibrios;  in  other  instances  this  did 
not  appear  to  be  the  case.  Many  pregnant  ewes  were  in- 
oculated with  the  vibrios  by  various  channels.  Some  of 
these  aborted,  but  for  the  most  part  they  did  not.  In  some 
of  the  aborts  and  the  uteri  of  the  aborters  the  vibrio  could 
be  identified;  in  some  it  could  not.  The  grounds  for  assum- 
ing that  the  inoculated  ewes  did  not  already  carry  in  utero 
the  vibrios  are  not  stated,  and  apparently  no  controls  were 
kept.  Nothing  is  submitted  to  show  that  these  ewes  taken 
from  their  familiar  suroundings  would  not  have  aborted  in 
the  same  ratio  if  not  inoculated.     The  evidence  that  a  preg- 

1  Abortion  in  Sheep.     Board  of  Agriculture  and  Fisheries.     London,  1913. 


720  Diseases  of  the  Genital  Organs 

nant  ewe  can  be  made  to  abort  during  her  existing  preg- 
nancy by  inoculating  with  vibrio  or  other  organism  is  cer- 
tainly far  from  conclusive.  The  complexity  of  experimen- 
tal proof  is  essentially  the  same  as  in  cattle,  which  has  been 
considered  at  length. 

Opportunity  was  afforded  me  and  my  colleague,  Car- 
penter', for  a  brief  study  of  a  disease  affecting  pregnant 
ewes,  many  of  which  aborted.  The  owner  made  a  practice 
of  purchasing  Western  ewe  lambs  (that  is,  lambs  grown  up- 
on the  Rocky  Mountain  plateau)  in  the  stockyard  at  Chi- 
cago or  Buffalo,  securing  purebred  rams,  breeding  them  for 
two  years,  marketing  the  lambs,  and  finally  the  matured 
ewes.  The  operations  had  been  remunerative  and  success- 
ful. 

In  1917  he  purchased  252  ewe  lambs  and  imported  from 
Canada  four  purebred  Shropshire  ram  lambs  as  sires.  This 
gave  to  each  ram  59  females,  involving  an  average  minimum 
of  3  ewes  in  estrum  each  day  for  each  ram.  The  result  was 
209  lambs,  or  an  increase  of  89  per  cent.,  which  indicated 
reasonable  sexual  health.  The  ideal  ratio  would  have  been 
at  least  11  per  cent,  higher.  The  same  rams  were  used  the 
next  year,  no  new  sheep  of  either  sex  having  been  added.  So 
far  as  known  there  was,  with  one  exception,  no  contact  with 
other  sheep.  Moreover  all  neighboring  flocks,  so  far  as  could 
be  learned,  were  healthy.  The  one  exception  as  to  contact 
was  that,  a  few  days  prior  to  the  intended  breeding  opera- 
tions, a  Tunis  ram  broke  into  the  premises  and  copulated 
with  some  of  the  ewes.  Twelve  of  these,  all  so  far  as  known 
that  copulated  with  the  Tunis  ram,  gave  birth  to  18  cross- 
bred lambs,  all  of  which  lived.  There  remained,  according 
to  the  caretakers,  223  ewes,  which  were  bred  to  the  same 
Shropshire  rams  used  the  previous  pear.  When  pregnancy 
in  these  had  become  sufficiently  advanced  to  render  the  ex- 
pulsion of  fetal  cadavers  obvious,  abortions  began  to  be  ob- 
served. The  223  ewes  bred  to  the  Shropshire  rams  pro- 
duced 127  viable  lambs  (57  per  cent.)  Some  ewes  which 
failed  to  produce  lambs  were  not  observed  to  expel  fetal 

'RL'jJortN.  Y.  State-  W-lt-riiiary  CoIU'^f  at  Coriull  I'liis.,  U)iS- n),  paj^c  123. 


General  Infections  of  the  Genitalia  of  Sheep  and  Goats      7  2 1 

cadavers,  although  perhaps  they  did  so  at  an  early  date. 
The  ewes  were  generally  unthrifty.  This  may  have  been 
due  partly  to  the  food,  which,  though  abundant,  did  not  ap- 
pear to  be  first-class.  A  formidable  objection  to  attributing 
the  bad  condition  of  the  ewes  to  low-grade  food  was  the  fact 
that  the  ewes  with  which  the  Tunis  ram  had  mated  were  in 
good  flesh  and  vigorous,  although  they  were  kept  in  the  same 
flock  throughout  and  were  handled  identically,  except  that 
they  had  conceived  a  few  days  earlier  to  a  different  ram. 

Of  the  223  ewes  bred  to  the  Shropshire  rams  25  (11  per 
cent.)  perished.  Some  succumbed  after  the  fetus  had  per- 
ished and  macerated  in  the  uterus ;  others  died  at  virtually 
full  term,  the  fetus  being  fully  developed  but  showing  evi- 
dences of  disease  which  proved  fatal  to  it  at,  or  slightly  prior 
to,  the  death  of  the  ewe.  Other  ewes  died  after  parturition 
or  abortion.  The  mortality  in  the  ewes  was  apparently  the 
result  of  a  general  sepsis  rather  than  of  local  genital  lesions. 
That  is,  the  genital  lesions  were  macroscopically  of  a  com- 
paratively mild  degree  and  failed  to  impress  the  observer  as 
being  in  themselves  extremely  perilous. 

In  general  the  badly  diseased  ewes  suffered  from  dysen- 
tery. The  feces  were  very  thin,  fetid,  and  black.  No  cause 
for  the  dysentery  other  than  the  genital  infection  was  rec- 
ognizable. Its  general  clinical  character  reminded  us  of  the 
dysentery  occurring  in  septic  metritis  in  pregnant  and  puer- 
peral cows,  already  described.  The  disease  began  early  in 
pregnancy  and  gained  constantly  in  force  until  pregnancy 
had  terminated,  when  some  animals,  though  not  all,  gradu- 
ally improved.  Some  which  were  not  pregnant,  but  perhaps 
had  been,  though  the  embryo  had  perished,  continued  to  fail 
and  eventually  died  in  extreme  emaciation  without  showing 
marked  genital  or  other  lesions.  Those  which  perished 
after  lambing  or  aborting  generally  showed  metritis  with 
accumulations  of  exudates  varying  in  volume,  color  and 
consistency. 

The  expulsion  of  the  fetuses,  dead  or  alive,  viable  or 
mortally  ill,  was  tardy  and  atonic.  The  ewes  were  evidently 
weak.  Vigorous  expulsive  efforts  were  wanting.  The  fun- 
46 


722  Diseases  of  the  Genital  Organs 

damental  atony  was  referable  to  the  uterus.  Prior  to  abor- 
tion there  was  often  a  dirty  sanious  discharge  from  the 
vulva  for  several  days,  and  finally  when  the  fetus  was  ex- 
pelled it  had  undergone  putrefaction  and  maceration.  This 
is  highly  characteristic  of  the  metritis  of  pregnancy  in  ewes, 
so  far  as  now  known.  McFadyean  and  Stockman  in  their 
observations  record  that  sanious  vulvar  discharge  common- 
ly occurs  some  days  prior  to  the  expulsion  of  the  fetal  cada- 
ver, which,  in  their  experience,  was  usually  putrefying  or 
macerating. 

This  is  in  marked  contrast  to  the  observations  in  cattle 
abortion.  Generally  in  cattle  the  expelled  fetal  cadaver  is 
fresh  and  shows  merely  traces  of  the  beginning  of  decom- 
position. In  exceptional  cases,  as  noted  while  considering 
abortion  in  cattle,  the  embryo  or  fetus  macerates  or  putre- 
fies prior  to  expulsion,  or  it  putrefies  and  is  permanently 
retained.  The  prevailing  behavior  of  the  uterus  toward  a 
contained  dead  fetus  is,  therefore,  essentially  reversed  in 
the  cow  and  the  ewe.  In  the  cow  the  endometritis  at  the 
cervical  end  of  the  uterus  has  a  marked  tendency  to  cause 
contraction  of  the  walls  of  the  comparatively  sound  ovarian 
end  of  the  uterus,  through  which  the  fetus,  dead  or  alive, 
is  forced  into  the  cervix,  dilating  the  latter  and  causing  in 
turn  expulsive  contractions  of  the  abdominal  walls.  But. 
as  pointed  out,  if  the  infection  within  the  uterus  spreads  too 
rapidly  toward  the  ovarian  end,  or  begins  there  and  para- 
lyzes the  muscular  walls,  expulsion  fails  and  retention  with 
putrefaction  follows.  Instead  of  such  maceration  being  the 
exception,  it  becomes  the  rule  in  ewes.  This  is  probably 
largely  due  to  an  earlier  and  more  severe  involvement  of  the 
ovarian  end  of  the  ovine  uterus.  It  may  be  due  partly  in 
some  cases  to  the  existence  of  twin  pregnancy.  Twins  rare- 
ly perish  simultaneously,  and  as  a  rule  the  first  embryo  to 
perish  is  retained  within  the  uterus  until  the  second  fetus 
either  perishes  or  reaches  fetal  maturity.  Then  the  uterus 
contracts  and  either  twin  abortion  or  birth  and  abortion 
concurrently  ensue.  Thus,  in  twin  abortion,  the  fetuses  are 
unlike  in  development  and  in  post-mortem  changes.     One 


Genera/  Infections  of  the  Genitalia  of  Sheep  and  Goats       723 

twin  is  smaller  than  the  other.  It  had  perished  at  an  early 
date  and  had  undergone  partial  maceration  or  desiccation. 
Such  is  the  rule  in  twin  abortion  in  the  cow  and  almost  with- 
out exception  in  twin  abortion  in  the  mare.  The  same  con- 
dition is  observed  in  twin  abortion  in  woman.  In  swine 
(presumably  also  in  carnivora)  embryos  often  perish  but, 
so  long  as  other  healthy  embryos  exist,  the  expulsion  of  the 
cadavers  is  inhibited  until  all  have  perished  or  time  for 
parturition  has  been  reached.  In  other  instances  fetal  re- 
tention with  maceration  is  apparently  referable  to  an  in- 
tense sclerotic  or  adhesive  cervicitis  which  prevents  cervical 
dilation  and  thus  incarcerates  the  fetal  cadaver.  In  some 
years  this  becomes  somewhat  common  in  certain  flocks,  and 
ewe  after  ewe  succumbs.  In  these  instances  there  are  ex- 
pulsive contractions  of  the  abdominal  walls  without  concur- 
rent contractions  of  the  uterine  walls  of  such  power  as  to 
dilate  the  cervical  canal.  The  abdominal  straining  forces 
the  gravid  uterus  into  the  pelvis,  pushing  the  cervix  in  front 
of  it  through  the  vulva  to  the  exterior — prolapse  of  the 
cervix. 

The  studies  of  Carpenter  and  myself  in  the  outbreak 
mentioned  failed  to  establish  clearly  the  etiology.  Carpen- 
ter recognized  a  spirillum  in  the  uteri  of  three  out  of  eight 
slaughtered  ewes.  Two  of  the  ewes  carrying  spirilla  had 
aborted,  and  one  had  given  birth  to  a  viable  lamb.  In  only 
one  uterus  was  the  spirillum  recognized  unassociated  with 
other  bacteria  (pure  culture).  Bacteria  were  recovered 
from  the  uterus  or  placentae  of  each  of  the  eight  ewes  ex- 
amined. The  list  included,  in  addition  to  the  spirillum, 
colon-aerogenes,  streptococci,  staphylococci,  and  short  oval 
rods  in  pairs. 

Experimentally  we  failed  to  establish  any  important  facts. 
We  purchased  two  pregnant  ewes  which  were  wild  and 
placed  them  in  my  experiment  stable,  where  they  were  very 
timid  and  uneasy.  As  is  usual,  the  seller  reported  that  he 
had  observed  no  abortions  or  disease  of  lambs  in  his  flock. 
Each  ewe  received  in  her  jugular  10  cc.  of  composite  stom- 
ach fluids  from  three  fetuses,  the  fluid  from  each  source  con- 


724  Diseases  of  the  Genital  Organs 

taining  an  abundance  of  vigorous  spirilla.  One  of  the  ewes 
expelled  a  macerating  fetal  cadaver  fourteen  days  after  the 
inoculation.  The  maceration  indicated  that  it  had  died  at  a 
period  quite  in  advance  of  its  expulsion,  but  how  long  before 
could  not  be  told.  It  may  have  been  dead  when  the  inocula- 
tion was  made.  The  ewe  was  immediately  slaughtered,  but 
no  spirilla  were  obtained  from  either  uterus  or  fetus.  Cul- 
tures showed  streptococcus  viridans  and  colon-aerogenes. 
The  other  ewe  gave  birth  to  an  apparently  healthy  lamb 
thirty-two  days  after  inoculation.  Both  animals  were  des- 
troyed. Spirilla  were  recovered  from  the  uterus  of  the  ewe, 
but  not  from  the  lamb.  Consequently  the  spirillum  was  re- 
covered from  the  apparently  healthy  ewe  but  could  not  be 
found  in  the  aborter  or  abort. 

We  also  inoculated  in  the  jugular  two  pregnant  cows  with 
20  cc.  of  the  same  material  as  that  used  in  the  ewes.  One 
of  these  was  64  days  pregnant,  pregnancy  having  been  veri- 
fied by  rectal  palpation.  She  was  not  observed  to  abort  but 
was  in  estrum  forty  days  after  inoculation  and  her  uterus 
found  empty.  Cultures  obtained  from  her  uterus  with  cath- 
eter showed  staphylococci.  Immediately  after  the  inocula- 
tion she  had  shown  alarming  symptoms  resembling  anaphy- 
laxis, but  these  passed  in  two  or  three  hours.  She  evidently 
expelled  an  embryonic  cadaver  subsequent  to  the  inoculation 
but  there  was  no  conclusive  evidence  of  the  cause  of  the 
abortion.  She  had  aborted  three  years  before,  was  out  of 
an  aborting  cow,  and  her  sire  was  in  service  in  a  virulently 
infected  herd.  She  was  pregnant  by  an  apparently  healthy 
bull. 

As  the  other  heifer  had  been  purchased,  she  was  without 
history.  She  was  well  advanced  in  pregnancy  and  gave 
birth  sixty-five  days  after  inoculation  to  a  very  poor,  weak 
calf  weighing  49  pounds.  Fluid  siphoned  from  her  stomach 
yielded  staphylococci.  The  calf  lived  and  remains  in  the 
herd.    Her  behavior  as  a  calf  is  shown  in  Figs.  208-200. 

Our  experiments  failed  to  show  that  the  spirillum  causes 
abortion  in  sheep,  although  it  probably  plays  an  important 
part.    These  experiments  are  essentially  parallel  in  results 


GeJieral  Infections  of  the  Genitalia  of  Sheep  and  Goats       725 

with  those  of  McFadyean  and  Stockman,  though  the  conclu- 
sions drawn  from  them  may  vary.  We  secured  no  uniform- 
ity of  result  and  kept  no  controls.  The  spirillum  may  have 
been  present  in  the  genital  tract  of  the  one  ewe  prior  to  in- 
oculation. McFadyean  and  Stockman  appear  to  believe  that 
the  death  of  the  ovine  fetus  is  brought  about  by  one  microbe 
and  its  maceration  by  others.  Perhaps  this  belief  is  general 
in  abortion  in  all  animals  and  possibly  is  borrowed  from  ob- 
servations upon  post-natal  death.  There  a  given  infection 
commonly  causes  death  and  other  bacteria  (usually  already 
present  in  the  body,  as  the  colon  bacilli  in  the  intestines)  re- 
leased from  the  restraint  of  the  living  tissues  quickly  break 
down  the  cadaver. 

Intra-uterine  death  presents  a  quite  different  problem. 
Putrefaction  or  maceration  of  the  embryo  is  dependent  upon 
the  invasion  of  the  cadaver  by  putrefactive  bacteria,  just  as 
in  post-natal  life,  but  the  invasion  is  subject  to  important 
limitations  because  the  embryo  physiologically  is  hermeti- 
cally sealed  within  the  uterus.  McFadyean  and  Stockman 
apparently  believe  that,  when  the  embryo  perishes  in  the 
uterus,  the  cervical  canal  opens  and  permits  free  invasion 
from  the  exterior.  My  observations  lead  me  to  believe  that 
abortion  is  associated  either  with  a  cervicitis  which  pre- 
vents the  formation  of  the  uterine  seal  or  with  a  cervical 
endometritis  which  destroys  the  uterine  seal.  In  the  first 
instance  it  is  highly  probable,  if  not  certain,  that  the  bac- 
teria of  pyocervicitis  can  cause  fetal  putrefaction  and  macer- 
ation as  well  as  metritis,  chorionitis,  fetal  dysentery,  sepsis 
and  death.  In  the  second  instance  the  bacteria  incarcerated 
within  the  sealed  gravid  uterus,  which  have  power  to  cause 
endometritis,  destruction  of  the  uterine  seal  and  fatal  dis- 
ease of  the  fetus,  quite  certainly  possess  putrefactive  or 
macerating  powers.  This  is  well  illustrated  in  the  macera- 
ting embryos  in  swine.  These  largely  occur  at  the  cervical 
or  ovarian  end  of  the  uterus,  but  may  occur  in  the  middle 
of  an  embryo  row,  flanked  upon  either  side  by  apparently 
healthy  embryos.  These  macerate,  putrefy  and,  if  not  too 
old,  are  absorbed,  but  they  are  wholly  shut  off  from  invasion 


726  Diseases  0/  the  Genital  Orgayis 

from  the  exterior.  The  bacteria  causing  death  and  macera- 
tion are  apparently  identical,  and  I  consider  it  logical  to  as- 
sume that,  as  a  rule,  the  destiny  of  an  embryonic  cadaver  is 
largely  fixed  by  the  nature  of  the  infection  causing  its  death. 
In  swine  there  are  plenty  of  bacteria  incarcerated  within  the 
gravid  uterus.  They  regularly  cause  necrosis  with  varying 
degrees  of  maceration  or  desiccation  of  each  fetal  sac  at  its 
poles.  The  same  bacteria  logically  have  power  to  cause  solu- 
tion of  a  necrotic  embryo.  So  in  the  ewe  the  uterus  regu- 
larly contains  necrosis-producing  bacteria  which  produce 
necrosis  of  the  tips  of  the  embryonic  sac,  and  it  would  be 
very  difficult  to  understand  why  the  same  bacteria  may  not 
cause  maceration  of  a  necrotic  embryo.  As  the  evidence 
now  stands,  it  appears  that  the  death  of  the  fetus  and  its 
maceration  are  generally  referable  to  the  activities 
of  the  same  organism  or  group  of  organisms.  As  in 
cattle,  so  in  sheep,  the  infection  already  exists  in  the  cervix 
or  uterus  at  the  moment  of  coitus,  or  is  introduced  as  a 
component  part  of  the  semen  during  coitus.  A  little  later 
the  cervical  canal,  if  healthy,  is  sealed  and  invasion  thereby 
inhibited. 

In  the  outbreak  of  genital  disease  of  ewes  studied  by  Car- 
penter and  me,  the  history  of  the  herd  points  strongly  to 
the  rams  as  the  essential  source  of  the  infections  and  to 
coitus  as  the  date  of  invasion.  As  related,  a  Tunis  ram 
broke  into  the  inclosure  and  copulated  successfully  with 
some  ewes.  These  remained  apparently  healthy  and  pro- 
duced vigorous  lambs.  When  the  Shropshire  rams  were 
placed  with  the  ewes,  the  disease  began  with  those  which 
were  still  non-pregnant.  Those  ewes  bred  to  the  Shropshire 
rams  began  aborting  eight  or  ten  weeks  before  the  Tunis 
lambs  were  born.  There  was  abundant  time  for  a  contagion 
to  spread  rapidly  by  ordinary  contact  from  an  aborting  ewe 
to  a  healthy  pregnant  one,  but  this  failed  to  occur.  The  out- 
break also  suggests  that  the  infection,  as  a  highly  destruc- 
tive force,  developed  in  what  may  be  termed  a  spontaneous 
manner.  That  is,  the  infection  existed  during  the  prior 
breeding  season  in  low  virulence,  depressing  the  reproduc- 


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General  Infections  of  the  Genitalia  of  Sheep  and  Goafs    727 

tive  efficiency  of  the  herd  ten  per  cent,  or  more  below  the 
ideal,  but  arousing  no  alarm.  Notable  dystocia  had  been 
present,  but,  in  accordance  with  the  general  view,  was  at- 
tributed to  large  lambs  as  compared  with  the  birth  passages 
of  the  young  ewes,  instead  of  being  referred,  as  was  proba- 
bly the  fact,  to  uterine  inertia  resulting  from  infection. 
When  the  Shropshire  rams  were  placed  with  the  ewes  for  the 
second  breeding  season,  each  ram  faced  the  task  of  copu- 
lating once  to  several  times  with  each  of  fifty  ewes  within  a 
period  of  twenty-one  days.  The  infection  gathered  momen- 
tum rapidly  and  serious  disaster  followed. 

As  in  cattle,  so  in  sheep,  there  is,  so  far  as  known,  nothing 
which  can  be  done  to  check  abortion  in  pregnant  ewes.  It 
can  be  prevented  only  by  mating  males  and  females  which 
are  genitally  sound.  Secondarily,  all  those  influences  of 
food,  water,  air  and  exercise  which,  properly  adjusted,  in- 
sure the  highest  degree  of  physical  vigor,  play  an  important 
part  in  increasing  the  resistance  of  the  uterus  to  the  infec- 
tions virtually  always  present  in  small  degree. 

Rams  should  be  handled  with  the  greatest  possible  care  in 
order  to  insure  their  sexual  vigor.  Plenty  of  vigorous  exer- 
cise during  the  long  season  of  sexual  rest  is  a  prime  factor 
in  the  promotion  of  physical  and  sexual  vigor  and  endur- 
ance. It  is  to  be  remembered  that  an  adult  breeding  male, 
when  at  sexual  rest,  requires  very  little  food  and  that,  un- 
less vigorous  exercise  is  in  some  manner  provided,  he 
quickly  becomes  atonic,  lethargic  and  obese.  In  this  state 
infections  present  in  any  organ  constantly  tend  to  develop 
increasing  force.  When  a  male  so  weakened  is  subjected  to 
severe  sexual  strain,  each  coitus  intensifies  any  genital  in- 
fection present  and  endangers  his  fertility.  Therefore,  the 
two  chief  precautions  to  be  taken  are  the  enhancing  of  physi- 
cal vigor  during  the  period  of  sexual  rest,  and  a  safe  limita- 
tion as  to  the  number  of  females  he  is  expected  to  serve. 
During  the  rest  period  the  ram  should  have  a  moderate  ra- 
tion, for  which  he  should  be  obliged  to  travel  enough  to  en- 
sure vigor.  The  most  practicable  plan  is  to  permit  the  ram 
to  run  with  wethers,  cattle  or  other  animals  than  ewes  dur- 


728  Diseases  of  the  Genital  Organs 

ing  the  non-breeding  season.  During  the  breeding  season 
the  number  of  ewes  assigned  to  a  ram  should  be  carefully 
limited.  Ordinarily  when  the  ram  is  placed  with  the  flock, 
all  ewes  are  sexually  ready  for  breeding  and  will  be  in  es- 
trum  within  three  weeks,  so  that  it  may  be  assumed  that  the 
male  will  copulate  at  least  once  with  each  ewe  within  that 
time  and  will  at  first  probably  copulate  several  times  with 
each  ewe.  According  to  such  observations  as  I  have  been 
able  to  make,  small  flocks  constantly  show  higher  reproduc- 
tive efliciency  arid  more  vigorous  offspring  than  large 
ones.  Many  elements  doubtless  enter  into  the  problem, 
but  I  believe  the  most  important  factor,  assuming  that  the 
general  care  is  good,  is  the  proper  limitation  of  the  sex 
strain  upon  the  ram.  The  large  breeds  of  sheep  are  essen- 
tially twin  breeders  and  if  properly  handled  may,  and  some- 
times do,  average  throughout  the  flock  two  lambs  each.  Thus 
in  one  flock  twenty-six  ewes  produced  fifty-two  vigorous 
lambs,  there  having  been  enough  triplets  to  counterbalance 
singles.  It  is  probable  that  such  a  number  of  ewes  is  near 
to  or  quite  the  maximum  for  one  ram,  if  the  highest  effi- 
ciency is  to  be  maintained.  Admittedly  instances  may  be 
cited  where  rams  have  withstood  a  far  greater  sexual  strain 
with  apparent  impunity,  but  it  is  doubtful  policy  to  assume 
that  any  breeding  animal  is  wholly  and  technically  free 
from  genital  infections.  Knowing  these  to  be  essentially 
universal,  and  knowing  that  under  prudent  sex  or  physical 
strain  the  infections  are  generally  harmless,  it  appears  to 
me  best  to  assume  the  existence  of  infection  and  guard 
against  its  intensification.  The  cost  of  the  maintenance  of 
additional  rams,  beyond  the  value  of  the  fleece,  is  not  highly 
important  and  does  not  require  many  additional  lambs  to 
render  the  plan  economically  profitable.  Such  care  in  breed- 
ing is  not  merely  for  the  immediate  influence  upon  the  next 
lamb  crop.  The  progressive  breeder  must  always  contem- 
plate future  generations.  Health  lines  are  as  important  as 
blood  lines,  and  it  requires  as  great  patience  and  intelligence 
to  establish  that  physical  vigor  upon  which  high  i^'oductive 
efliciency  depends  as  it  does  to  build  nj)  a  satisfactory  pcMli- 


General  hifedions  of  the  Gefiitalia  of  Sheep  andCioats     729 

gree.  The  genital  infections  of  sheep,  like  those  of  other 
mammals,  behave  as  an  endless  chain.  If  a  ram  is  over- 
crowded and  develops  virulent  infection,  the  harm  does  not 
end  with  the  abortions  which  may  follow,  the  ewes  which 
may  perish,  or  the  slow  development  of  the  congenitally  dis- 
eased lambs.  Such  lambs  may  be  perilously  infected  and, 
upon  reaching  breeding  age,  serve  as  a  new  center  for  the 
distribution  of  dangerous  infection. 

Wherever  it  is  economically  practicable,  it  is  better  to 
divide  large  flocks  into  small  breeding  units  and  assign  to 
each  unit  a  breeding  ram.  By  such  means,  if  there  be  one 
dangerous  ram  in  the  flock,  he  is  identified  and  the  infection 
limited  to  his  group  of  ewes.  The  division  of  the  flock  into 
small  breeding  units  may  be  for  a  brief  time  only,  not  ex- 
ceeding four  weeks,  when  the  breeding  should  be  terminated 
and  any  ewe  proving  unfertile,  assuming  that  the  ram  is 
sound,  should  be  discarded  for  breeding  because  she  proba- 
bly carries  dangerous  genital  infections  which  it  is  well  to 
avoid. 

Death  and  maceration  of  the  fetus,  ivith  prolapse  of  the 
cervix,  has  been  mentioned  as  occurring  frequently  in  preg- 
nant ewes.  Usually  the  cases  are  disseminated  and  involve 
only  a  small  percentage  of  a  flock,  but  individual  cases  often 
develop  annually.  The  pathology  and  bacteriology  have  not 
been  studied.  The  disease  reveals  itself  first  by  the  cervical 
prolapse.  As  in  the  pregnant  cow,  so  in  the  ewe,  the  cervix 
is  at  first  visible  only  when  the  patient  is  recumbent,  in 
which  position  the  intra-abdominal  tension  is  increased  and 
the  inert  genital  organs  mechanically  forced  out  through  the 
vulva.  The  cervix  becomes  befouled  with  litter,  desiccated 
and  irritated  by  the  air,  and  inflammation  and  necrosis  fol- 
low. Cervical  prolapse  in  the  pregnant  ewe  does  not  al- 
ways indicate  fetal  death  and  maceration.  I  handled  one 
case  in  which  the  ewe  gave  birth  to  vigorous  twins,  but  that 
is  merely  an  exception.  The  cervicitis  tends  constantly  to 
grow  worse.  The  cervix  becomes  swollen  and  indurated, 
rendering  it  more  and  more  difficult  for  the  canal  to  be 
dilated. 


73°  Diseases  of  the  Genital  Organs 

No  definite  line  of  treatment  has  become  established.  If 
it  can  be  determined  that  the  fetus  is  alive,  it  may  be  desira- 
ble to  try  to  retain  the  cervix  within  the  vagina.  It  should 
be  kept  clean  and  parturition  awaited.  The  retention  may 
be  secured  by  the  vulvar  sutures  shown  in  Fig.  60  for  vagi- 
nal hernia  of  cows.  Securely  retained  and  protected  from 
soiling  and  the  irritation  of  drying  in  the  air,  the  cervix 
may  be  kept  clean  and  soothed  by  means  of  irrigations  with 
salt  solution  or  with  bland  oils.  This  may  relieve  the  cervi- 
citis and  the  induration,  causing  the  cervix  to  relax  and  the 
uterus  to  expel  its  contents.  It  may  be  attempted,  with 
some  hope  of  success,  to  cause  contraction  of  the  uterus  with 
dilation  of  the  cervix  by  small  repeated  doses  of  pituitary 
extract.  These  failing,  gastrohysterotomy  may  be  employed, 
as  described  for  the  cow,  and  the  uterine  contents  removed 
surgically.  , 

Retained  Fetal  Membranes.  The  metritis  which  sometimes 
results  in  abortion  in  the  ewe  tends  also  to  cause  retention 
of  the  fetal  membranes.  The  character  of  the  cotyledons  in 
the  ewe  alters  notably  the  type  of  the  placental  retention. 
In  the  cow  the  cotyledons  are  intimately  attached  to  the 
chorion  over  a  large  area,  so  that  the  two  tissues  do  not 
readily  tear  apart.  The  fetal  cotyledons  of  the  cow  may  be 
described  as  sessile;  the  maternal  cotyledons  are  distinctly 
pedunculate.  This  is  reversed  in  the  ewe :  the  maternal  pla- 
centa is  essentially  sessile,  while  the  fetal  placenta  is  dis- 
tinctly pedunculate,  with  a  long,  slender  pedicle.  In  the 
coM^  the  pedicle  of  the  maternal  cotyledon  often  parts  and  the 
maternal  placenta  falls  away ;  in  the  ewe  the  pedicle  of  the 
fetal  cotyledon  quickly  parts,  and  the  chorion  and  amnion 
drop  away,  leaving  the  spherical  fetal  cotyledons  (See  Figs. 
31,  32)  incarcerated  in  the  chalice-like  cavity  of  the  mater- 
nal cotyledon,  as  shown  in  Fig.  214  and  in  Colored  Plate  VII. 

It  is  only  in  a  minority  of  cases  of  retained  placenta  in  the 
ewe  that  the  chorion  and  amnion  are  included  in  the  reten- 
tion. Usually,  therefore,  the  retention  is  not  evidenced  by 
the  membranes  protruding  from  the  vulva.  Such  cases  are 
observed,  but  arc  usually  of  short  duration.     So  long  as  the 


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General  Infections  of  the  Genitalia  of  Sheep  and  Goats       731 

chorion  remains  attached  to  the  cotyledon  and  hangs  from 
the  vulva,  the  symptoms  render  the  character  of  the  disease 
evident,  but  the  more  frequent  condition  of  retained  cotyle- 
dons, after  the  falling  away  of  the  chorion,  is  not  readily 
diagnosable  clinically.    The  genital  passages  do  not  admit 


Fig.  214. — Retained  Placenta  in  Ewe. 
C,  Chorion  ;  U,  uterus  ;  /,  fetal  (above)  and  maternal  cotyledons  (below) 
showing  hemorrhagic  placentae  ;  2,  cross  section  through  fetal  and  maternal 
cotyledons,  showing  narrow  neck  of  fetal  portion  ;  7,  fetal  cotyledon  de- 
taciied  from  uterus  and  showing  at  its  base  a  hemorrhagic  zone  ;  5,  uterine 
cotyledon  everted  ;  6,  uterine  cotyledon  with  fetal  placenta  removed. 

manual  examination  of  the  interior  of  the  uterus.  The  diag- 
nosis must  then  rest  upon  the  presence  of  the  metritic  dis- 
charge, usually  dark  red,  sanious,  mixed  with  necrotic  pla- 
cental fragments,  and  fetid.  The  diagnosis  is  clear  enough 
as  to  metritis,  but  not  as  clear,  except  for  the  placental  frag- 
ments, as  to  retained  placenta.  The  differentiation,  however, 
between  metritis  with  or  without  placental  retention  is  not 
profoundly  important.  They  possess  essentially  the  same 
dangers  and  call  for  analogous  handling. 


732  Diseases  of  the  Genital  Organs 

The  retained  cotyledons  can  not  be  removed  by  any  technic 
at  present  known.  If  a  rubber  horse  catheter  can  be  success- 
fully passed  into  the  uterine  cavity,  the  contents  may  be 
diluted  with  saline  solution  and  siphoned  out.  This  can  not 
be  done  safely  if  the  chorion  is  still  attached.  A  small 
amount  of  iodoform  and  bismuth  (30  to  40  grains  of  each) 
suspended  in  two  to  four  ounces  of  liquid  paraffin  may  be 
introduced  into  the  uterine  cavity.  Pituitrin  may  be  tried 
in  small  doses  (10  to  20  drops)  frequently  repeated. 

The  infections  involving  the  fetus  and  the  new-born  lamb, 
whatever  may  be  their  identity,  cause  approximately  the 
same  lesions  as  already  described  in  bovine  fetuses  and  in 
calves.  A  notable  result,  as  in  bovine  fetuses  and  new-born 
calves,  is  severe  dysentery  with  gastro-intestinal  lesions. 
Carpenter,  in  his  autopsies  of  fetuses  which  had  perished 
in  utero,  records  essentially  universal  diarrhea.  The  amnio- 
tic fluid  contained  meconium,  showing  that  the  fetus  had 
defecated — a  distinctly  pathologic  act.  This  is  illustrated 
in  Colored  Plate  VII,  where  pellets  of  meconium  are  shown 
lying  between  the  fetus  and  the  amnion.  The  existence  of 
fetal  dysentery  was  further  shown  by  the  presence  of  me- 
conium in  the  stomachs  of  aborts,  which  location  could  be 
reached  only  by  the  fetus  having  defecated  and  later  swal- 
lowed the  meconium  suspended  in  the  amniotic  fluids.  Most 
lambs  born  in  the  flock  were  thickly  smeared  over  with  me- 
conium, indicating  clearly  that  they  had.  as  fetuses,  suf- 
fered from  diarrhea. 

Except  for  the  few  Tunis  lambs  previously  mentioned^ 
nearly  all  lambs  born  were  weak  and  sick  at  birth.  They 
were  extremely  emaciated  and  were  dull  and  weak.  Cov- 
ered as  they  were  with  meconium,  they  were  often  repulsive 
to  their  dams.  The  ewes  refused  to  lick  their  young,  leaving 
them  befouled  with  meconium.  Frequently  they  would  not 
permit  the  lambs  to  suck,  but  would  butt  them  over  when 
they  approached.  The  caretakers  in  many  cases  caught  and 
restrained  the  ewe  each  time  that  the  lamb  fed. 

These  observations  are  interesting,  because  they  possibly 
throw  light  upon  other  instances  where  a  dam   refuses  to 


General  Infections  of  the  Genitalia  of  Sheep  and  Goats       733 

care  for  her  new-born,  or  resorts  to  cannabalism  as  ob- 
served in  swine.  It  is  not  impossible  that  the  repulsion  of 
the  new-born  by  its  mother  is  often  due  to  disease — that  the 
fetus  has  suffered  from  dysentery  due  to  an  infection  pres- 
ent in  the  uterine  cavity  of  the  mother  and  the  new-born  is 
repulsively  covered  with  filth,  having  an  odor  unlike  that 
which  is  natural  to  the  species.  In  swine,  necrotic  embryos 
are  expelled  with  pigs.  The  scavenger  sow  devours  the  mac- 
erating embryos  and  the  pigs,  having  the  same  filth  smeared 
over  them,  are  also  eaten. 

The  lambs  in  the  flock  observed  largely  suffered  from 
dysentery.  Their  development  was  tardy,  partly  because  of 
the  intense  infection,  but  largely  because  the  ewes,  due  to 
illness,  had  little  milk.  Many  of  the  weaker  lambs  died 
from  one  to  two  hours  up  to  three  or  four  days  after  birth. 

The  post-mortem  appearances  of  fetuses  dead  in  utero  and 
lambs  which  perished  shortly  after  birth  were  analogous  to 
those  of  bovine  fetal  cavaders  and  calves  dead  from  dysen- 
tery. Outbreaks  of  disease  in  new-born  lambs  are  not  rare 
and  run  essentially  parallel,  in  cause,  symptoms,  course,  re- 
sults and  post-mortem  findings,  to  those  diseases  of  the  calf 
having  their  foundations  in  infection  during  intra-uterine 
life.  They  suffer  from  dysentery,  pneumonia  and  arthritis. 
Each  of  the  three  consequences  may  result  from  post-natal 
infection,  but  the  most  basic  cause  is  to  be  sought  in  the 
intra-uterine  infection  of  the  pregnant  animal.  The  infec- 
tion grows  through  the  chorion  and  amnion,  gains  the  am- 
niotic fluid,  and,  being  swallowed  by  the  embryo,  begins  its 
destructive  career  by  inducing  gastro-enteritis  with  dysen- 
tery or,  in  some  cases,  sepsis,  whether  the  storm  breaks 
ante-  or  post-natal. 

The  handling  of  the  infections  of  new-born  lambs  is  to 
be  based  upon  the  principles  laid  down  for  calves  and  does 
not  require  repetition  here.  Serologic  handling  has  not 
been  placed  upon  a  secure  basis,  so  far  as  known.  The  serum 
sold  for  dysentery  in  calves,  given  in  proper  dosage,  would 
probably  prove  beneficial.  The  objection  will  at  once  be 
raised  that  such  a  course  would  be  illogical  because  in  the 


734  Diseases  of  tlic  denital  Organs 

"calf  scours  serum"  the  bacteria  used  in  preparing  the 
serum  are  those  of  "calf  scours" — not  of  "lamb  scours".  It 
has  been  pointed  out,  however,  that  the  bacteriology  of 
neither  has  been  clearly  established,  and  furthermore  that 
it  has  not  been  demonstrated  that  ordinary  horse  serum  is 
not  quite  as  efficacious  as  is  that  from  horses  "immunized" 
against  large  doses  of  the  presumptive  "calf  scours"  bac- 
teria. 

Genital  infections  in  goats  have  been  reported  from  time 
to  time,  but  the  goat  industry  is  confined  to  comparatively 
small  areas  except  for  scattering  individuals  of  nominal 
value,  and  the  subject  has  consequently  received  no  sus- 
tained interest.  When  goats  become  concentrated  in  large 
numbers  and  are  intensely  bred,  fed  and  milked,  they  tend 
ultimately  to  yield  to  genital  infections  similarly  to  cattle. 

Stone  and  Fisher'  have  investigated  an  infection  in  goats 
bearing  some  resemblance  to  goat  pox,  but  not  identifiable 
with  that  malady.  The  disease  was  closely  associated  with 
pregnancy  and  apparently  led  in  numerous  instances  to 
abortion.  In  the  doe  the  symptoms  of  disease,  consisting 
chiefly  of  pustules,  abscesses  and  multiple  arthritis,  usu- 
ally followed  closely  upon  parturition  or  abortion.  The  cu- 
taneous pustules  were  followed  by  necrotic  areas.  The  ab- 
scesses were  generally  subcutaneous.  Some  of  them  ma- 
tured and  broke;  others  became  caseous  and  indolent.  The 
multiple  arthritis  was  of  the  ordinary  type  so  frequent  in 
cows  after  intra-uterine  infection,  and  in  calves,  foals  and 
other  young  following  intra-uterine  and  navel  infections. 
The  method  of  infection  was  not  clearl^^  determined.  In 
some  instances  the  disease  was  contracted  through  a  healthy 
doe's  being  sent  into  an  infected  herd  to  be  bred,  but  no  evi- 
dence was  submitted  to  indicate  that  the  inoculation  oc- 
curred through  coitus.  Many  does  aborted  or  became  ster- 
ile, or  both.  The  kids  born  of  the  infected  does  largely  de- 
veloped the  same  symptoms,  especially  the  polyarthritis. 

In  the  outbreaks  directly  covered  by  the  report.  Stone  and 

'A  Clironic  Pox-like  Infection   in    (loats    and    Its    Sncccssful    Tnatuiont 
Jour.  Am.   Vet.  Med.  A.ss'ii,  \'ol.  S,  y.  5V),   Ani;.,  igiy. 


General  Infections  of  the  Genitalia  of  Sheep  and  Goats    735 

Fisher  regularly  obtained,  in  cultures  from  the  pustules  and 
abscesses,  a  pure  growth  of  a  staphylococcus.  Some  individ- 
uals showed  merely  a  few  pustules,  which  after  a  short  in- 
terval healed,  and  the  animals  showed  thereafter  an  imper- 
fect immunity.  A  large  percentage  of  cases  did  not  recover 
spontaneously  and  were  obstinate  to  symptomatic  handling, 
such  as  antiseptics,  the  opening  of  the  abscesses,  etc.  They 
were  highly  successful,  however,  in  the  use  of  autogenous 
bacterins.  As  the  work  progressed,  they  used  successfully 
bacterins  made  by  combining  cultures  procured  from  vari- 
ous similar  cases. 

The  relationship,  if  any  existed,  between  the  disease  de- 
scribed by  Stone  and  Fisher,  believed  to  be  due  to  staphylo- 
cocci, and  the  abortion  and  sterility  was  not  made  clear,  but 
they  believed,  upon  apparently  excellent  grounds,  that  the 
interferences  with  reproduction  were  basic  results  of  the 
malady. 

In  other  instances  abortions  in  goats  occur  in  which  the 
staphylococcus  described  can  not  be  found,  but  other  bac- 
teria are  present.  In  some  instances,  also,  the  fetus  per- 
ishes and,  owing  to  uterine  inertia  with  cervical  induration, 
retention  of  the  fetus  follows.  Then  prolapse  of  the  cervix 
ensues,  having  the  same  general  characters  as  the  cervical 
prolapse  of  the  ewe  already  described. 

Since  the  general  principles  of  controlling  genital  infec- 
tions in  goats  are  the  same  as  those  advised  for  cattle  and 
sheep,  repetition  is  unnecessary. 


SECTION  III.     THE  GENITAL  INFECTIONS  OF  SWINE 

CHAPTER  XVIII 
SPECIFIC  GENITAL  INFECTIONS 

The  Nodular  Venereal  Disease 
Outbreaks  of  specific  venereal  diseases  in  swine  have  been 
recorded  at  intervals,  but  the  records  have  been  indefinite. 
When  describing  the  nodular  venereal  disease  of  cattle,  it 
was  stated  that  the  infection  is  common  in  cattle,  swine, 
sheep,  and  presumably  in  goats.  It  has  been  stated  by  some 
writers  that  in  certain  herds  the  infection  caused  destruc- 
tive outbreaks  of  abortion  and  sterility  in  sows.  The  facts 
appear  to  be  that  notable  losses  occurring  in  certain  herds 
of  swine  caused  the  veterinarian  to  search  for,  and  quite 
naturally  to  find,  the  lesions,  and  upon  this  evidence  the  con- 
clusion was  reached  that  the  infection  causing  the  lesions 
was  responsible  for  the  abortion.  The  assumption  may  be 
true  or  untrue.  What  has  been  said  of  the  infection  in  cattle 
is  presumably  equally  true  in  swine,  and  it  does  not  re- 
quire repetition. 

CHAPTER  XIX 
NON  VENEREAL  SPECIFIC  INFECTIONS  INVADING 
THE  GENITALIA  OF  SWINE 
Genital  Tuberculosis 
Genital  tuberculosis  has  been  reported  but  rarely  in  swine 
and  probably  does  not  play  a  very  important  economic  part 
in  swine  husbandry.    I  have  in  my  collection  but  one  speci- 
men of  genital  tuberculosis  of  swine — tuberculosis  of  the 
testicle,  illustrated  in  Fig.  215.    The  gland  is  from  a  pure- 
bred boar  belonging  to  a  herd  devoted  to  growing  purebred 
swine  for  breeding  purposes.   They  had  a  liberal  supply  of 
raw  milk  from  a  herd  of  purebred  dairy  cattle  in  which  tu- 
berculosis was  rampant.   The  symptoms  of  genital  tubercu- 
losis in  swine  are  presumably  the  same  as  in  cattle.    The 
tuberculosis  of  swine  is  ordinarily  of  bovine  origin.    Tuber- 
cular invasion  of  the  genitalia  of  swine  is  to  be  avoided  by 
the   general   measures   for   preventing   swine   tuberculosis. 
When  present,  genital  tuberculosis  has  the  same  dangers  for 
other  swine  that  bovine  genital  tuberculosis  has  for  other 
cattle.   There  is  no  remedy  for  the  affected  animal. 


Genital  Tuberculosis 


111 


Fig.  215 — Tuberculosis  of  Testis.     Boar. 
A,  Median  section  :  B,  external  side  of  testicle  showing  epididymis. 
/,  Spermatic  cord  ;    2,  head  of  epididymis  ;    j,  tubercular  masses  ;  7,  tuber- 
cular abscess  cavitv  ;  5,  body  of  epididymis  :  6,  section  through 
epididymis  revealing  tubercular  masses. 

47 


CHAPTER  XX 

THE  GENERAL  INFECTIONS  OF  THE 
GENITALIA  OF  SWINE 

The  general  infections  of  the  genitaha  of  swine  are  of  far 
greater  economic  importance  than  has  yet  been  generally 
recognized.  Adult  sows  (and  probably  also  gilts)  ordinarily 
discharge  at  each  estrum  twelve  to  eighteen  or  more  ova. 
If  each  ovum  were  physiologically  healthy,  the  genital  tract 
healthy,  and  the  sow  copulated  with  a  thoroughly  healthy 
boar,  there  would  be  a  vigorous  live  pig  born  for  each  ovum 
discharged.  It  was  stated,  while  considering  reproduction 
in  cattle,  that  in  purebred  dairy  herds  there  is  born  as  a 
rule  about  one  viable  calf  for  each  three  copulations,  or 
that  about  67  per  cent,  of  the  efforts  at  reproduction  fail. 
A  similar  condition  exists  in  the  production  of  swine,  but 
the  result  is  screened  from  general  observation.  Since  the 
sow  is  multiparous,  if  infection  of  her  genital  tract  is  mod- 
erate only,  some  of  the  ova  may  be  fertilized,  develop,  and 
be  born  in  viable  health.  The  same  is  true  of  the  boar.  If 
infection  exists  in  his  genitalia  which  destroys  but  a  part 
of  the  spermatozoa  or  later  brings  about  the  death  of  only 
a  portion  of  the  embryos,  some  pigs  are  born,  but  the  num- 
ber is  depressed  in  harmony  with  the  amount  of  the  infec- 
tion existing  within  the  uterus  of  the  sow  at  the  date  of 
coitus,  plus  the  infection  ejaculated  with  the  semen  of  the 
boar.  So  far  as  I  am  able  to  estimate,  these  infections  re- 
duce the  number  of  pigs  born  upon  the  average  50  per  cent, 
which  means  that  swine  breeders  maintain  two  brood  sows 
to  perform  the  ideal  work  of  one.  The  swine  breeder  ordi- 
narily does  not  comprehend  the  meaning  of  a  litter  of  four 
to  six  pigs,  and  unconsciously  attributes  the  low  fertility  to 
some  vagary  of  "nature",  but  a  careful  study  of  gravid 
swine  uteri  in  the  abattoir  permits  a  (luite  dilferent  inter- 
pretation. 

Abattoir  studies  of  ])r('gnant  swine  ulcri  rex  eal  s(>\i'ral 
very  interesting  and  impoi-tant    farts  which  ari'  lii.uiily   il- 


The  General  Infections  of  the  Cenitalia  of  Swine  739 

lustrative  of  some  of  the  fundamental  principles  of  genital 
infections  and  the  physiology  and  pathology  of  reproduction 
in  general. 

The  embryonic  sacs  of  swine  testify  emphatically  to  es- 
sentially universal  intra-uterine  infection  of  significance. 
Embryologists  have  described  the  necrotic  tips  of  the  em- 
bryonic sacs  of  swine  as  ''normal"  by  which  the  reader  as- 
sumes this  necrosis  to  be  physiologic.  Bonnet  apparently 
regards  the  phenomenon  as  the  result  of  pressure  necrosis. 
That  is,  the  embryonic  sac  outgrows  the  length  of  the  uter- 
ine (cornual)  cavity  and,  pressing  the  apices  of  the  sacs 
either  against  the  apex  of  the  cornu  or  against  adjacent  em- 
bryos, by  pressure  cuts  off  the  nutrition  of  the  chorion,  so 
that  the  part  dies.  Numerous  facts  contradict  this  assump- 
tion. It  is  generally  contrary  to  physiologic  development 
that  an  organ  or  tissue  should  undergo  dry  necrosis  and  be- 
come in  effect  a  permanent  (during  gestation)  foreign  body. 
Instead  useless  organs  or  tissues  usually  undergo  cellular 
disintegration  with  resorption.  The  necrosis  at  the  poles  of 
the  embryonic  sacs  is  inconstant  in  occurrence  and  extent. 
It  is  not  always  present.  The  necrosis  increases  with  the 
advancement  of  pregnancy,  as  would  be  expected  of  a 
chronic  infection.  When  some  of  the  embryos  are  necrotic, 
the  necrosis  of  the  tips  of  the  other  embryonic  sacs  contain- 
ing live  embryos  is  more  extensive  than  that  observed  in 
uteri  where  all  embryos  are  apparently  healthy.  From 
whatever  angle  the  phenomenon  is  viewed,  it  is  difficult  to 
escape  the  conviction  that  the  necrosis  commonly  present  at 
the  two  poles  of  each  embryonic  sac  of  swine  is  the  result 
of  a  chronic  intra-uterine  infection  which  existed,  or  was 
introduced,  at  the  time  of  coitus,  and  that  death  of  swine 
embryos  is  ordinarily  referable  to  an  extension  of  such  polar 
necrosis.  The  path  of  invasion  appears  to  be  through  the 
amnion  from  the  necrotic  area,  after  which  the  embryo 
swallows  the  bacteria  and  the  active  invasion  of  the  embryo 
itself  begins  within  the  alimentary  tract. 

There  are  many  scattered  records  of  abortion  in  swine, 
but  in  most  reports  it  is  not  made  clear  what  the  observers 


740  Diseases  of  the  Genital  Organs 

mean.  When  considering  abortion  in  cows,  it  was  stated 
that  commonly  the  word  signified  the  observed  expulsion  of 
a  fetal  cadaver.  In  the  sow  there  may  be  expelled  at  one 
time  macerating  embryos  of  varying  sizes  and  degrees  of 
decomposition,  fetuses  recently  dead,  poorly  developed,  sick 
pigs,  and  fully  developed,  viable  pigs.  Such  a  medley  is 
difficult  of  accurate  definition.  There  are  present,  in  the  one 
uterine  evacuation,  phenomena  which  may  be  designated  as 
abortion,  stillbirth,  premature  birth,  and  birth.  Accord- 
ingly it  is  difficult  to  interpret  the  precise  meaning  of  a 
writer  when  he  says  that  sows  have  aborted.  In  some  in- 
stances, like  those  reported  by  Hayes  and  Traum',  who  re- 
cord that,  out  of  seventy  sows,  twelve  aborted  at  from  the 
forty-third  to  the  one  hundred  eighth  day  of  pregnancy,  it 
seems  clear  that  the  uteri  of  the  sows  were  at  the  times 
named  emptied  of  their  embryonic  contents  and  that  the 
embryos  were  dead.  There  is  no  intimation,  however,  as  to 
whether  the  embryos  in  a  given  uterus  had  perished  at  vari- 
ous dates,  as  shown  by  size  and  degree  of  maceration,  or 
whether  they  had  apparently  perished  simultaneously.  Ac- 
cording to  my  abattoir  studies  and  such  clinical  observations 
as  have  been  available,  the  course  and  character  of  genital 
infections  in  swine  conform  to  the  basic  principles  of  geni- 
tal infections  in  cattle,  modified  profoundly  in  some  respects 
by  the  muciparous  type  of  reproduction  and  significant  dif- 
ferences in  the  handling  of  animals.  Probably  no  animal 
carries  infections  in  the  genital  organs  more  universally  or 
in  larger  volume.  The  ovaries  do  not  show  lesions  with  the 
same  frequency  as  the  dairy  cow,  but  the  same  varieties  of 
disease  are  present.  Fig.  216  illustrates  the  physiologic  cy- 
cles occurring  in  the  ovary  with  one  ovary  (2)  illustrating 
ovarian  adhesions  as  a  result  of  salpingitis.  Fig.  217  illus- 
trates cystic  disease  of  both  ovaries.  Without  history,  the 
latter  was  quite  certainly  a  nymphomaniac  and  sterile.  The 
symptoms,  as  I  have  observed  clinically  in  other  cases,  are 
essentially  the  same  as  described  in  cattle.  There  is  sex 
perversion  shown  in  the  behavior  of  the  sow  towards  other 
domestic  animals.     I  have  not  observed  the  sinking  of  the 

'Preliminary  Rcpurt  on  Abortion  in  Swine  caused  by  B.  Abortus  (Bang.)  North  Am.  \'ct.. 
May,  1920. 


The  General  Infections  of  the  Genitalia  of  Su'ine         741 


Fig.  2 16— Ovaries  of  Sow. 
/,  Ovary  showing  6  ripe  ovisacs  (on  left)  with  apex  of  cornu  to  the  right 
and  above  ;  2,  small  fibrous  ovary  on  left,  with  adhesions  in  pavilion.  (The 
oviduct  has  been  divided  just  beneath  2)  \  j,  ovary  showing  immature 
ovisacs  ;  -/,  5,  ovaries  showing  corpora  lutea  ;  6,  ovary  in  rest  stage  showing 
atrophied  yellow  bodies. 


'42 


Diseases  of  the  Cjenital  Organs 


I'K..  -'17— Cystic  Ovaries.     Sow. 

/,  /,  Cj'slic  ovisacs,  lieiualli  wliioli   arc  a])ices  of   uttiiiR-  lioriis  si'tii   I'loii 

dorsal  surface  ;   9,  ovary,  with  normal  ovisacs  introduced  as  check.      ( Ikdow 

the  a])ices  of  two  uterine  horns  with  ovarii's  and  cystic  oviducts  are  showi 

from   ventral   surface)    /,    a  small   cyst  in  nu'sosalpinx   immediately    al)ovi 


The  General  Infections  of  the  Cenitalia  of  Sivine  743 

pelvic  ligaments  in  the  sow  which  is  so  prominent  a  feature 
in  the  cow. 

Hydrosalpinx  occurs  in  swine,  as  in  cows.  In  Fig.  218 
there  is  illustrated  an  interesting  instance  of  extreme  bilat- 
eral hydrosalpinx  in  a  pregnant  sow,  showing  that  severe 
tubal  infection  may  exist  at  the  date  of  coitus  without  in- 
hibiting fertilization  and  then  develop  so  rapidly  that  long 


Fig.  21S— Bilateral  Hydrosalpinx  Developed  During 
Pregnancy.      Sow. 

/,  /,  The  cornua  each  contains  a  normal  embryo  \"  long  ;  2,  abscess  in  apex 

of  horn,  probably  embryonic  debris ;  j,  ovary  sectioned,  showing  small 

cysts  ;  4,  cystic  distension  of  adherent  pavilion  ;  5,  cystic  oviduct. 

before  the  end  of  pregnancy  the  reproductive  life  of  the  sow 
has  been  permanently  closed — unless  one  believes  that  the 
tubal  infection  was  post-coital. 

The  gravid  uterus  of  the  sow,  the  embryonic  envelopes, 
and  the  embryos  show  essentially  all  the  lesions  already  de- 
scribed for  the  cow,  and  it  is  only  necessary  to  point  out 
here  certain  deviations  in  type  due  to  fundamental  differ- 
ences in  the  species.  Intra-uterine  infection  with  necrosis 
of  the  poles  of  the  embryonic  sacs  is  so  nearly  universal 


744  Diseases  of  the  Genital  Orga7is 

that,  as  previously  stated,  it  is  designated  "normal".  Ne- 
crosis and  maceration  of  embryos  is  exceedingly  common, 
I  have  been  able  to  recognize  necrotic  embryos  not  over  one- 
eighth  of  an  inch  long,  but  naturally  such  are  not  often  rec- 
ognized. They  commonly  macerate  quickly,  so  far  as  I  have 
been  able  to  determine,  and  are  absorbed.  This  probably 
accounts  in  a  large  measure  for  the  disparity  in  numbers 


Fig.  J19 — Desiccated  "Mole"  in  Swine  Uterus. 

/,    Desiccated  embryonic  sac  lying  in  base  of   uterine  cornu     (The  opened 

vagina  and  cervix  extend   to  the  right,  above)  ;  J,  apparently  healthy 

embryo  from  same  cornu  ;  j,  necrotic  tip  of  fetal  sac. 

between  the  corpora  lutea  present  in  the  ovaries  and  the 
embryos  in  the  uterus.  Some  of  the  discharged  ova  presuma- 
bly failed  of  fertilization.  Following  the  minimum  recog- 
nizable necrotic  embryo,  there  occurs  every  possible  grada- 
tion of  necrosis,  maceration  and  desiccation.  There  are 
great  variations  in  one  uterus.  Sometimes  there  is  a  desic- 
cated "mole"  in  which  the  minute  embryo  has  perished  and 
is  no  longer  visible,  while  the  embryonic  sac  remains  as  a 
desiccated,  wrinkled  cord  or  band,  as  shown  in   Fig.  219. 


The  General  Infectiojis  of  the  Genitalia  of  Swine  745 

Then  follow  various  sizes  of  necrotic  embryos  which  have 
undergone  varying  degrees  of  maceration  or  desiccation,  as 
shown  in  Figures  220  to  222.  One  necrotic  embryo  may  be 
one-half  to  one  inch  long  and  almost  wholly  disintegrated, 
rendering  its  identification  difficult.  A  contiguous  dead  em- 
bryo may  be  two  or  three  inches  long  with  only  slight 
maceration  or  desiccation.     Neighboring  live  embryos  may 


Fig.  220 — Necrotic  Swine  Embryo  (right)  with  Necrotic  Fetal  Sac. 
The  cadaver  was  expelled  at  full  term  with  8  healthy  young. 

be  four  to  six  inches  or  more  in  length.  The  live  embryos 
show  great  variations  in  size — sometimes  100  per  cent,  vari- 
ation in  volume.  The  small  fetus,  the  "runt"  to  be,  is  ap- 
parently small  as  a  result  of  nutritive  disturbances  owing 
to  the  ravages  of  infection,  and  when  born  is  wanting  in 
vigor. 

Embryonic  death  may  occur  in  any  order,  but  as  a  rule 
the  liability  of  the  embryo  to  succumb  to  intra-uterine  in- 
fection conforms  to  the  general  principles  laid  down  for  the 
cow.  The  most  vulnerable  points  are  the  cervical  end  of  the 
uterus  and  the  apices  of  the  cornua.    As  a  rule  the  first  to 


746  Diseases  of  the  Genital  Organs 

perish  is  the  basal  embryo — that  is,  the  embryo  which  is 
located  in  the  base  of  one  horn  nearest  to  the  cervical  canal 
and  whose  embryonic  sac  extends  across  the  uterine  mouth 
of  the  cervical  canal  into  the  opposite  horn.  The  embryonic 
sac  of  this  basal  fetus  constitutes  the  "sentinel"  which  the 
infection,  more  virulent  than  elsewhere,  must  pass  in  order 
to  imperil  the  lives  of  embryos  beyond.  This  is  strikingly 
illustrated  clinically  in  the  dystocia  of  the  sow  dependent 
upon  fetal  maceration  and  emphysema.  The  difficulty  is 
commonly  with  the  basal  fetus  which,  having  perished  and 
undergone  maceration  at  or  near  full  term,  since  the  occu- 
pied segment  of  the  uterus  is  paretic,  can  not  be  expelled, 
and  so  bars  the  path  of  exit  of  the  fetuses  beyond,  whether 
living  or  dead.  Consequently  in  a  large  proportion  of  cavses, 
if  the  basal  fetus  can  be  successfully  removed,  parturition 
may  proceed  favorably. 

In  multipara  the  death  of  one  or  more  embryos  has  little 
or  no  visible  tendency  to  cause  the  uterus  to  contract  and 
empty  its  contents,  so  long  as  living  and  comparatively 
healthy  embryos  remain,  but  the  necrotic  fetal  cadaver  or 
cadavers,  with  the  envelopes,  remain  in  situ  and  undergo 
maceration  or  desiccation.  That  is,  the  presence  of  an  im- 
mature, healthy  embryo  in  the  uterus  serves  to  inhibit  uter- 
ine contractions  which  would  expel  indifferently  dead  and 
living  embryos.  In  this  manner  the  reproductive  efficiency 
of  swine  is  partly  maintained  although  the  average  number 
of  3^oung  produced  at  a  birth  is  greatly  curtailed. 

The  infections  of  the  genitalia  of  swine  have  not  been 
comprehensively  studied.  Good  and  Smith,  Hayes  and 
Traum,  and  others  have  searched  for,  and  have  frequently 
found,  the  B.  abortus  in  aborting  sows,  or  have  found  that 
the  blood  of  aborting  sows,  or  of  boars  to  which  aborting 
sows  were  bred,  reacted  to  the  tests  for  that  organism,  and 
concluded  therefore  that  in  these  instances  it  was  the  es- 
sential cause.  Apparently  other  pathogenic  bacteria  were 
not  looked  for  and  the  conclusion  that  the  B.  abortut^  was  the 
causative  agent  was  apparently  based  upon  the  assumption 
that  the  B.  abortus  is  t]ir  specific  cause  of  abortion  in  cattle. 


The  General  hiJeclio7is  of  the  Genitalia  of  Sivine 


IM 


Fig.   221 — Necrotic  Swine  Embryos. 

/,  2,  Necrotic  embryos  (the  membranes  incised  to  bring  them  into  view) 

J,  a  necrotic  embryonic  sac  in  which  the  embryo  can  not  be  found  ; 

4,  J,  healthy  fetuses  from  same  uterus. 


Fig.  222 — Necrotic  and  Healthy  Swine  Embryos  from  Same  XJten 
/,  Necrotic  embryo  ;    2,  healthy  embryo;  j',  necrotic  tips. 


748  Diseases  of  the  Geyiital  Organs 

and  that  consequently  it  causes  abortion  in  other  animals 
which  it  may  invade.  Having  carved  out  the  idol  of  specific 
contagious  abortion  in  cattle,  it  becomes  obligatory  upon  the 
part  of  those  who  thus  believe  to  have  a  specific  contagious 
abortion  for  each  species  of  mammal  in  order  to  account  for 
intra-uterine  death  which  overtakes  and  destroys  a  large 
proportion  of  embryos  in  every  land  and  in  all  species  of 
mammalia.  Perhaps  no  animal  furnishes  more  direct  evi- 
dence of  the  non-existence  of  a  specific  infection  with  a  di- 
rect abortifacient  action  than  the  sow.  One  embryo  or  five 
or  six  embryos  in  the  uterus  of  the  sow  may  succumb  to  in- 
fection present,  but  the  infection  is  impotent  to  cause  the 
expulsion  of  the  cadaver  or  cadavers  so  long  as  a  healthy 
immature  fetus  remains.  If,  however,  all  embryos  die  or 
become  seriously  ill,  the  endometrium  is  generally  involved 
and  the  diseased  organ  revolts  and  expels  its  perilous  con- 
tents. Otherwise  the  orderly  completion  of  pregnancy  pro- 
ceeds, and  at  full  term  the  living  fetuses  are  born  and  the 
cadavers  are  expelled.  The  uterus  accordingly  evacuates  its 
contents  in  two  ways — the  ordinary  physiologic  birth  when 
the  fruit  is  ripe,  and  the  pathologic  expulsion  of  its  con- 
tents when  the  embryo  or  embryos  and  their  coverings  are 
dead  or  seriously  diseased,  associated  with  concurrent  dis- 
ease of  the  endometrium  identical  in  cause.  Any  organism 
capable  of  causing  endometritis  and  placentitis  with  death 
or  critical  illness  of  the  intra-uterine  young  may  and  does 
lead  to  abortion,  but  no  microorganism  is  yet  known  which 
can  directly  and  specifically  cause  uterine  contractions. 

The  B.  abortus  is  a  common  resident  of  the  genital  tract 
of  sows  which  abort  or  are  sterile.  It  is  common  in  boars. 
It  is  not  known  to  be  uncommon  in  healthy  swine.  Its  com- 
mon presence  where  abortion  and  sterility  prevail  justifies 
the  belief  that  it  is  one  of  the  bacteria  which  serve  to  inter- 
fere with  reproduction.  But  there  are  other  organisms  pres- 
ent, along  with  the  B.  abortuf^,  which  have  not  been  studied 
and  the  significance  of  which  can  not  now  be  guessed. 

The  control  of  the  genital  infections  of  swine  is  to  be  at- 
tained by  the  adaptation  and  application  of  the  principles  al- 


The  General  Infections  of  the  Genitalia  of  Szvine  749 

ready  considered  at  length  for  the  analogous  infections  of 
cattle.  The  individual  value  of  swine  and  the  anatomical 
conditions  largely  inhibit  individual  handling  and  call  for 
preventive  measures  en  masse.  Swine  are  largely  handled 
as  scavengers  and  consumers  of  foods  repulsive  to  other 
domestic  animals.  Near  cities  they  are  fed  largely  upon 
garbage.  There  is  a  general  tendency  to  handle  swine  as 
lovers  of  filth  and  as  immune  to  dirt. 

Throughout  history  swine  have  been  closely  associated 
with  cattle,  have  consumed  their  waste  milk,  salvaged  un- 
digested grains  from  their  feces,  consumed  the  viscera  of 
slaughtered  cattle,  and  devoured  the  carcasses  of  diseased 
cattle.  In  this  long  and  intimate  association  there  is  a 
natural  tendency  for  community  of  bacteria.  It  is  not 
strange  therefore  to  find  that  B.  abortus  and  other  bacteria 
common  in  bovine  genitalia  are  similarly  prevalent  in  swine 
and  have  an  analogous  significance. 

In  one  interesting  clinical  study  it  appeared  that  this  in- 
timacy of  association  exerted  an  important  influence  upon 
the  fertility  of  swine.  In  a  large  herd  of  purebred  dairy 
cattle,  genital  infections  were  intense.  There  were  heavy 
losses  from  abortion,  but  heavier  losses  from  sterility  due 
to  cervicitis  and  salpingitis  in  the  cows,  and  to  epididymitis 
and  spermato-cystitis  in  the  herd  bulls.  B.  abortus  was  pres- 
ent, but  the  major  role  was  apparently  played  by  a  strepto- 
coccus of  the  viridans  type.  The  establishment  also  had  a 
purebred  herd  of  swine,  in  which  the  reproductive  efficiency 
gradually  decreased  until  the  herd  became  a  distinct  eco- 
nomic burden.  Little  abortion  was  observed,  but  a  major- 
ity of  the  females  were  sterile.  As  it  was  desired  to  develop 
the  pigs  as  rapidly  as  possible,  their  mothers'  milk  was  sup- 
plemented by  all  the  dairy  milk  they  would  take.  I  recom- 
mended that  no  further  raw  dairy  milk  be  allowed  to  swine 
of  any  age  or  either  sex.  All  milk  was  to  be  boiled.  The 
herd  was  divided  into  three  groups.  In  the  first  group 
were  listed  all  sows  which  had  been  used  for  breeding  and 
which  had  disappeared  from  the  herd  when  the  change  in 
the  feeding  of  dairy  milk  was  made.   The  second  group  in- 


750  Diseases  of  the  Genital  Organs 

eluded  all  females  which  had  been  fed  raw  milk  and  which, 
under  the  new  plan,  received  boiled  milk.  The  third  group 
consisted  of  females  born  after  the  recommendation  had 
gone  into  force,  which  had  received  throughout  their  lives 
only  cooked  milk. 

In  the  first  group  there  were  11  females  which  were  kept 
in  the  herd  a  total  of  131  months  after  they  had  reached 
breeding  age.  They  produced  100  healthy  pigs — one  healthy 
pig  for  each  1.28  months,  or  9  1/3  pigs  a  year.  The  second 
group  comprised  25  sows  with  a  total  of  438  breeding 
months,  which  had  produced  207  healthy  pigs,  or  one  for 
each  2,11  months,  equivalent  to  5,68  pigs  per  year.  The 
third  group  comprised  8  sows  (at  date  of  making  up  statis- 
tics) which  had  been  kept  a  total  of  92  breeding  months  and 
which  had  produced  107  healthy  pigs,  or  one  pig  for  each 
0.85  months,  equivalent  to  14.1  pigs  per  annum.  Accord- 
ingly the  combined  efficiency  of  the  two  first  groups  was  an 
average  of  6.48  pigs  per  sow  per  year  as  opposed  to  14.1 
pigs  per  annum  in  the  final  group.  I  have  been  unable  to 
account  for  the  doubling  of  the  reproductive  efl^ciency  ex- 
cept by  the  change  in  the  plan  of  feeding  dairy  milk.  It  ap- 
pears, too,  that  it  was  not  the  feeding  of  the  adult  sows 
which  affected  the  breeding  efl^ciency,  but  the  more  hygienic 
feeding  of  the  young  pigs.  This  is  parallel  to  my  observa- 
tions upon  the  health  of  nursing  calves.  If  the  calf  is 
healthy,  whether  male  or  female,  it  will  be  fertile  when  it 
reaches  breeding  age,  but  if  it  has  diarrhea  or  pneumonia 
as  a  young  calf  its  fertility  as  an  adult  will  be  low.  I  do  not 
attribute  the  higher  fertility  in  the  third  group  to  the  killing 
of  the  Bang  organism  in  the  milk  fed,  nor  is  there  any  as- 
surance that  the  bacterial  content  in  the  milk  was  directly 
responsible.  It  may  well  have  been  that  the  living  bacteria 
in  the  milk  established  lesions  in  the  digestive  mucosa  (mu- 
co-enteritis,  dysentery)  which  prepared  an  open  portal  of 
entry  for  bacteria  already  present  in  the  intestines  of  the 
pig,  and  that  these,  passing  to  the  genital  tract.  i)ersist(Ml  to 
sex  maturity  and  impaired  reproduction. 


The  General  Infections  of  the  Genitalia  of  Szcine  751 

The  principles,  therefore,  in  controlling  losses  from  geni- 
tal infections  in  swine  are  to  grow  pigs  under  the  best  known 
hygienic  rules,  being  careful  not  to  overfeed,  keep  them  in 
the  cleanest  practicable  quarters  and,  when  using  cow's  milk 
or  by-products  thereof,  sterilize  the  latter  before  feeding. 
In  these  precautions  no  sex  distinction  is  to  be  made.  Sows 
should  be  closely  watched  in  parturition  and,  if  necrotic  em- 
bryos are  expelled  or  the  litter  is  low  in  number,  the  sow 
should  be  discarded  and  her  litter  go  with  her.  The  boar, 
too,  is  to  be  observed  carefully  and,  if  at  all  suspected, 
should  be  subjected  to  examination  by  a  skilled  veterinarian 
along  the  lines  already  traced  for  bulls. 

Swine  breeders  have  limited  their  care  in  mating  too 
strictly  to  the  avoidance  of  hog  cholera.  The  prudent 
breeder  should  use  great  care  in  accepting  sows  from  other 
herds  for  breeding  because  of  the  ever-present  danger  from 
infections  of  possibly  greater  virulence  than  those  existing 
within  the  herd.  In  selecting  males  for  breeding,  one  should 
be  taken  from  a  large  litter,  indicating  thereby  that  the 
dam  was  healthy  and  that  consequently  her  pigs  were,  in 
the  largest  available  degree,  also  sound.  The  general  rules 
of  care  regarding  moderate  feeding  and  abundant  exercise 
should  be  applied  intelligently. 


SECTION  IV.   THE  GENITAL  INFECTIONS  OF  HORSES 

CHAPTER  XXI 
THE  SPECIFIC  VENEREAL  DISEASES 

A.  Dourine 
Maladie  Du  Coit.     Beschalseuche 

Bibliography.  Baldrev,  Jour.  Comp.  Path,  and  Therap..  1905,  Vol.  18.  p.  7.  de  Does, 
Jahresbericht,  1902.  Hutvra  und  Marek,  Spezielle  Pathologie  und  Therapie.  Mohler, 
Eichhorn  and  Buck.  The  Diagnosis  of  Dourine  bv  Complement-Fixation,  Jour.  Ag.  Re- 
search, Vol.  I,  No.  2,  Nov.  10,  1913.  Thanhoffer,  Ueber  ZuchtUihme.  W.  L.  Williams,  Report 
Illinois  State  Board  of  Live  Stock  Commissioners,  1887. 

Dourine  of  the  horse  is  the  most  serious  specific  venereal 
disease  knov^n  among  domestic  animals,  on  account  of  its 
wide  geographical  distribution  and  the  mortality  and  loss 
caused  by  it.  It  is,  or  has  been,  widely  disseminated  in  Eu- 
rope, Asia,  Africa  and  North  America.  It  has  been  recog- 
nized for  more  than  a  century  and  has  appeared  in  all  the 
leading  countries  on  the  European  continent.  In  English- 
speaking  countries  it  was  first  recognized  by  the  author  at 
Wapella  in  DeWitt  County,  Illinois,  in  the  spring  of  1886, 
among  imported  French  draft  stallions  and  the  mares  which 
had  been  served  by  them.  The  disease  in  Illinois  apparently 
broke  out  in  1884  or  1885,  but  its  nature  was  not  determined 
until  1886,  and  even  then  its  seriousness  was  not  fully  ap- 
preciated. It  was  not  until  1887  that  vigorous  measures 
were  undertaken  for  its  control  and  eradication.  In  the 
meantime,  numerous  animals  had  been  sold  from  the  infected 
area  and  widely  disseminated  over  the  country  in  a  manner 
which  made  it  impracticable  to  trace  them  effectively  to 
their  ultimate  destination.  When  the  importance  of  the 
malady  became  recognized,  it  was  promptly  placed  under 
control  in  its  original  center  and  was  so  completely  eradi- 
cated that  up  to  the  present  time,  a  period  of  thirty-five 
years,  it  has  not  reappeared  in  that  territory. 

Since  that  time  the  affection  has  been  recognized  in  Neb- 
raska, South  Dakota,  and  the  province  of  Alberta.  Canada. 


Dour  hie  753 

In  these  areas  of  infection  the  disease  has  not  been  definitely 
traced  to  its  source.  The  outbreak  in  Illinois  was  believed 
to  have  been  introduced  by  stallions  imported  from  France, 
a  conclusion  which,  although  unproven,  time  has  not  served 
to  change.  The  affected  area  in  Illinois  produced  consider- 
able numbers  of  grade  draft  stallions  and  mares  which  were 
sold  to  go  to  the  West  and  Northwest  for  breeding  purposes, 
and,  although  it  cannot  be  clearly  shown,  there  is  good  reason 
to  conclude  that  this  outbreak  furnished  the  infection  for 
the  others  which  have  occurred  in  America. 

Nature.  Dourine  is  a  highly  infectious  venereal  disease 
transmitted  naturally  by  coition  only.  Experimentally  it 
may  be  transmitted  by  inoculation  to  other  animals  than 
solipeds.  It  is  due  to  a  protozoan  parasite  belonging  to  the 
trypanosoma  group.  This  parasite,  the  trijpanosomuyn 
equiperdum,  was  discovered  by  Rouget  in  1896,  and  its  re- 
lation to  the  disease  clearly  demonstrated  by  Schneider  and 
Buffard  in  1899.  The  trypanosome  of  dourine  is  a  one- 
celled  organism  provided  with  a  flagellum  at  the  anterior 
end.  It  is  about  18  to  26  microns  in  length  and,  when  ob- 
served in  the  living  state,  is  highly  motile.  It  occurs  in  the 
blood,  the  spinal  fluid,  the  discharge  from  the  genital 
organs,  the  plaques  of  the  skin,  and  perhaps  in  other  tissues 
and  fluids  of  the  infected  animal.  It  multiplies  by  longitud- 
inal division.  When  removed  from  an  animal  and  kept 
moist,  it  will  live  for  several  days  or  even  a  week. 

It  is  not  always  easily  found.  It  is  said  to  be  most  readily 
discovered  in  recently  formed  plaques.  Baldrey  says,  in  re- 
ference to  the  appearance  of  the  trypanosoma  in  the  fresh 
plaques,  *Tf  these  appear,  then  a  positive  diagnosis  can  be 
made ;  if  not,  the  case  is  not  dourine."  The  parasites  are 
said  to  disappear  quickly  from  the  plaques,  so  that  it  is  diffi- 
cult or  impossible  to  find  them  after  twenty-four  hours. 
They  may  be  found  in  the  discharge  from  the  vagina  or 
urethra  of  the  infected  animal,  but  it  seems  that  their  exis- 
tence here  is  not  as  uniform  as  in  the  fresh  plaques.  Some 
investigators  believe  that  they  are  quite  uniformly  present 
in  the  spinal  fluid.  It  is  generally  very  difficult  to  discover 
them  in  the  blood. 
48 


754  Diseases  of  the  Genital  Organs 

This  parasite  constitutes  an  exception  to  the  general  rule 
in  the  trypanosomic  group  of  diseases,  in  that  it  is  not 
transmitted  from  animal  to  animal  by  the  bite  of  an  insect. 

Sijmptoms.  The  period  of  incubation  following  natural 
infection  is  not  definitely  determined  and  varies  considerably 
in  different  cases.  Generally  there  appear  some  physical 
signs  of  disease  in  from  eight  to  ten  days  after  exposure, 
but  these  may  not  be  very  marked  and  may  pass  unnoticed 
by  an  inexperienced  observer. 

The  symptoms  of  the  disease  may  be  divided  into  three 
important  groups :  the  local  lesions  of  the  genital  organs  and 
the  contiguous  parts ;  those  of  the  skin  and  other  mucous 
membranes  than  that  of  the  genital  organs;  and  the  symp- 
toms which  emanate  from  the  central  nervous  system.  The 
local  symptoms  in  the  genital  organs  are  the  first  to  appear 
after  infection  and  usually  the  last  to  disappear  in  case  of 
recovery. 

In  the  stallion  there  usually  appears,  eight  to  ten  days  sub- 
sequent to  infection,  a  swelling  of  the  penis  and  prepuce, 
with  some  degree  of  protrusion  of  the  penis,  still  covered  by 
the  prepuce.  The  prepuce  shows  a  tense,  elastic  swelling 
and  has  a  smooth,  glistening  appearance.  If  the  urethra  is 
exposed  to  view,  its  meatus  will  be  found  swollen,  dark  red. 
and  intensely  injected.  From  it  exudes  a  small  amount  of  a 
thin,  dirty,  muco-purulent  discharge.  As  the  disease  pro- 
gresses, the  tumefaction  of  the  prepuce  and  penis  increases 
and  extends  to  the  sheath  and  scrotum,  which  may  eventually 
become  enormously  swollen  and  remain  in  an  indurated  con- 
dition for  one  to  two  years  or  more.  The  animal  gradually 
becomes  less  able  to  retain  the  penis  in  its  position,  and  the 
swollen  organ  protrudes  farther  and  farther  out  of  the 
sheath,  sometimes  extending  entirely  out  of  the  prepuce  and 
hanging  flaccid  and  fully  exposed.  The  discharge  from  the 
urethra  may  become  somewhat  ichorous  and,  with  the  gen- 
eral soiled  condition  of  the  penis  and  surrounding  parts, 
may  lead  to  ulcerations  and  erosions  upon  these.  Later  in 
the  course  of  the  disease,  the  weakened  condition  of  the 
tissues  of  the  part  may  lead  to  pui-uii'iit   iut'cction  and  the 


Douriiie 


755 


formation  of  abscesses  in  the  sheath,  scrotum  and  inguinal 
region.      (See  Figs.  223  and  224.) 

The  testicles  may  undergo  inflammation  and  swelling 
which  after  a  time  may  be  followed  by  atrophy,  and  they  may 
be  pushed  upward  by  the  swelling  or  abscesses  in  the  scrotum 


Fig.  223— stallion  in  Early  Stages  of  Dourine,    showing 
Edematous  Prepuce.     ( Baldrey. ) 

until  they  rest  high  up  in  the  inguinal  space  where  they  can 
not  be  readily  felt.  No  vesicles  or  pustules  occur  upon  the 
genitalia  as  an  essential  part  of  this  disease,  but  there  occurs 
with  considerable  uniformity  a  depigmentation  of  the  skin 
and  covering  of  the  penis,  so  that  it  may  largely  lose  its 
pigment  and  become  white.     This  depigmentation  begins 


756 


Diseases  of  the  Genital  Organs 


upon  the  penis  and  may  extend  to  the  prepuce,  sheath  and 
scrotum.  In  studying  this  symptom,  it  is  well  to  bear  in 
mind  that  in  gray  horses  and  in  those  having  white  eyes, 
faces  or  feet,  it  is  quite  common  to  observe  an  absence  of 
pigment  on  the  penis,  but  this  is  regular  in  outline,  whereas 
in  dourine  the  depigmentation  spreads  out  in  patches. 

In  the  mare,  about  eight  to  ten  days  after  infection  there 
appears  a  well  marked  swelling  of  the  lips  of  the  vulva.     The 


I'lc    224  — Dourine  showing  Penial  Paralysis.     (Baldrey.) 

mucous  membrane  of  the  vulva  and  vagina  is  intensely  in- 
jected and  swollen,  and  from  the  vulva  there  escapes  a  more 
or  less  profuse  discharge  of  a  mucous  or  muco-purulent 
character,  which  soils  the  tail  and  surrounding  parts.  The 
mare  urinates  frequently  in  small  quantities,  which  causes 
pain  as  indicated  by  straining,  stami)ing  witli  tlu>  fiH't.  and 
switching  of  the  tail. 

There  seems  to  be  an  increased  sexual  excitement,  which 


Doiirinc  757 

may  be  somewhat  misleading,  depending  largely  for  its  ex- 
pression upon  the  frequent  urination,  rather  than  upon  genu- 
ine sexual  desire. 

As  the  disease  progresses,  the  volume  of  the  discharge 
tends  to  increase.  In  some  cases  it  assumes  a  dirty  gray- 
ish color,  and  may  become  fetid.  The  swelling  of  the  vulva 
increases,  the  labiae  become  much  enlarged,  tense,  elastic, 
and  glistening.  Their  margins  stand  somewhat  apart,  so 
that  the  vulva  is  partly  open,  especially  at  its  lower  com- 
missure. 

Within  a  few  weeks  after  the  advent  of  the  disease,  there 
appears  quite  regularly  a  characteristic  loss  of  pigment  in 
the  skin  of  the  vulva  and  the  neighboring  parts.  This  de- 
pigmentation begins  along  the  margins  of  the  vulva,  with- 
out prior  vesicular  or  pustular  eruptions,  as  simple  white 
patches,  and  thence  extends  in  irregular  lines  or  spots,  until 
it  may  involve  the  entire  vulva,  perineum  and  anus.  The 
white  patches  have  irregular  borders  and  are  of  various 
shapes  and  sizes.  They  persist  for  several  months  and,  in 
case  of  the  apparent  recovery  of  the  animal,  tend  finally  to 
disappear,  fading  first  at  the  periphery,  while  upon  the  mar- 
gins of  the  vulvar  lips  they  persist  for  six  months  or  a  year. 
(See  Fig.  225.) 

Of  even  greater  diagnostic  significance  are  the  changes 
which  occur  in  the  clitoris.  Comparatively  early  in  the 
course  of  the  disease,  this  organ  becomes  swollen  and,  the 
vulva  being  somewhat  open  at  the  inferior  commissure,  be- 
comes visible  ordinarily  without  mechanically  parting  the 
labiae.  The  secretion  of  sebum  in  the  prepuce  of  the  clitoris 
apparently  ceases,  and  the  swollen  organ  becomes  dry  and 
glistening.  Depigmentation  of  the  clitoris  and  its  prepuce 
occurs  early  and  persists  for  one  to  two  years  in  those  mares 
which  apparently  recover.  In  my  experience  it  is  the  last 
symptom  to  disappear.  The  swollen,  depigmented  clitoris 
with  gaping  vulva  constitutes  one  of  the  most  uniform  and 
persistent  symptoms  of  the  malady  and  gives  to  the  vulva 
of  a  young  mare  the  appearance  of  extreme  old  age. 

Following  closely  upon  the  first  appearance  of  local  lesions, 


758  Diseases  of  the  Genital  ihgans 

within  a  few  weeks  after  infection,  there  appear  pecuHar 
and  pathognomonic  cutaneous  eruptions  in  the  form  of 
plaques,  or  elhptical  elevations.  These  eruptions  appear 
suddenly,  largely  about  the  flanks,  neck,  shoulders,  sides  and 
thighs,  as  more  or  less  circular  elevations,  one  to  several 


I'lc.  225 — Advanced  Dourine  in  Mare  with  Extreme  Emaciation  and 
Depigmentation  of  Vulvar  Lips.     (Ihitvia  ami  Marck.  ) 

inches  in  diameter.  The  margins  of  these  are  vciy  al)nii)t 
and  stand  up  above  the  level  of  the  healthy  skin  like  the 
eruptions  of  urticaria.  The  hairs  upon  them  are  erect. 
They  appear  suddenly,  usually  not  in  great  nnmbors.  hut  only 


Dourine  759 

one  to  five  or  six  at  a  time,  remain  a  few  days  and  disappear 
without  leaving  a  mark,  to  be  succeeded  by  a  new  crop.  It 
is  claimed  that  in  these  plaques  the  trypanosomes  are  very 
abundant  during  the  first  stages  of  their  existence,  but  as 
the  eruptions  grow  old  the  parasites  rapidly  disappear  from 
them. 

It  has  been  stated  that  the  plaques  may  cause  intense  itch- 
ing and  lead  the  animal  to  bite  or  rub  the  part  and  that  they 
sometimes  suppurate.  I  have  observed  none  of  these 
symptoms. 

It  is  not  uncommon  to  observe  in  the  later  stages  of  the  dis- 
ease a  more  or  less  profuse  discharge  from  the  nostrils. 
This  nasal  discharge  may  in  some  cases  be  suggestive  of 
glanders  and  superficial  ulceration  of  the  mucous  mem- 
brane may  rarely  be  present.  The  erosions,  when  present, 
have  no  specific  character  and  suggest  rather  a  necrosis  of 
a  greatly  debilitated  tissue  as  the  result  of  an  irritant  ap- 
plied externally.  It  must  not  be  forgotten  that  glanders 
and  dourine  may  coexist  and  that  the  latter  would,  naturally 
greatly  intensify  the  former. 

The  general  debility  or  cachexia  of  the  disease  shows  it- 
self clearly  in  lesions  of  the  skin.  Wounds  heal  tardily. 
If  the  animal  is  so  weak  that  it  is  recumbent  a  large  part 
of  the  time,  it  suffers  from  extensive  decubitis  gangrene. 

The  symptoms,  tvhich  are  largely  referable  to  the  nervous 
system,  appear  at  about  the  same  time  as  the  plaques.  The 
first  and  most  pronounced  of  this  group  is  usually  a  pro- 
gressive paresis,  which  is  chiefly  observable  in  the  hind  parts. 
At  first  there  is  an  unsteady  gait.  The  animal  brings  the 
hind  feet  forward  in  a  difficult  and  somewhat  uncertain 
manner.  There  is  a  tendency  to  drag  the  toe  along  the 
ground  or  to  strike  it  at  the  middle  of  the  stride.  When 
weight  is  placed  upon  the  foot  the  toe  is  usually  brought 
down  first,  with  the  fetlock  flexed,  and  the  heel  is  then 
lowered  suddenly.  While  standing,  there  is  a  tendency  for 
the  fetlocks  to  be  maintained  in  a  flexed  position  or  some- 
what knuckled  over.  This  knuckling  over,  whether  stand- 
ing or  during  progression,  is  a  rather  common  symptom  in 
trypanosomic,  if  not  protozoan  diseases  generally. 


760  Diseases  of  the  Genital  Organs 

The  imperfect  control  may  appear  in  one  or  both  hind 
limbs  or  may  alternate  between  the  two,  and  is  subject  to 
great  variation  from  day  to  day.  In  the  main  the  paresis 
reminds  one  of  locomotor  ataxia  of  man.  Sometimes  the 
partial  paralysis  is  of  a  somewhat  spasmodic  nature,  faintly 
resembling  stringhalt.  At  times  there  may  be  swelling 
about  an  articulation  and  the  animal  may  seem  to  be  lame 
in  the  joint.  As  the  disease  advances,  the  paresis  tends  to 
increase  until  there  is  such  complete  paralysis  that  the  ani- 
mal is  unable  to  rise  when  down.  When  the  patient  becomes 
unable  to  rise,  a  fatal  termination  usually  occurs  in  the 
course  of  a  few  days  to  several  weeks,  largely  hastened  by 
the  decubitis  and  the  accompanying  complications.  In  other 
cases,  after  being  recumbent  for  days  or  having  had  to  be 
assisted  in  rising  for  weeks,  the  animal  improves  and  event- 
ually apparently  recovers  . 

With,  and  even  before,  the  advent  of  the  paretic  symptoms, 
there  appears  a  very  rapid  emaciation,  which  is  especially 
prominent  in  the  posterior  parts  of  the  body.  The  emacia- 
tion is  rendered  especially  noticeable  from  the  fact  that  it 
occurs  in  spite  of  a  good  appetite,  and  the  allowance  of 
abundant  food  with  apparently  good  digestion.  It  seems 
that  both  the  paralysis  and  the  emaciation  are  largely  de- 
pendent upon  changes  taking  place  within  the  spinal  cord 
and  that  these  symptoms  naturally  become  most  marked 
in  those  portions  of  the  body  posterior  to  the  locality  in  the 
cord  where  the  chief  destruction  has  occurred.  The  symp- 
toms of  the  disturbances  of  the  nervous  system  are  not  con- 
fined to  any  portion  of  the  body,  and  there  is  frequently  ob- 
served a  paralysis  of  an  ear  or  eyelid  or  of  the  lips  or  nose. 
In  the  stallion  there  is  frequently  such  a  marked  change 
in  the  voice  that  he  can  not  whinny  naturally. 

The  sexual  desire  may  remain  unaffected  throughout  the 
disease.  In  many  stallions,  the  power  to  copulate  is  but  little 
impaired,  but  in  the  earlier  stages,  during  the  tumefaction 
of  the  prepuce  and  penis,  either  from  excessive  erection  or 
from  other  cause,  the  stallion  fails  in  many  cases  to  effect 
coition,  and,  late  in  the  course  of  disease,  the  same  inability 


Dourine  7^^ 

may  arise  from  loss  of  power  in  the  penis  or  from  extreme 
paralysis  of  the  posterior  parts. 

The  effect  of  the  disease  upon  the  powers  of  reproduction 
is  very  profound.  In  the  earlier  stages,  the  stallion  may  be 
capable  of  impregnating  mares,  which,  if  he  does  not  infect 
them  with  the  disease,  may  give  birth  to  healthy  foals.  As 
the  disease  progresses,  while  the  stallion  may  still  be  capable 
of  copulating,  he  is  usually  sterile.  The  mare  which  becomes 
infected  does  not  generally  conceive,  or,  if  she  does  conceive, 
aborts  so  early  that  the  conception  is  not  observed.  In  the 
Illinois  outbreak,  it  could  not  be  determined  that  a  foal  had 
been  born  among  one  hundred  diseased  mares.  Some  writ- 
ers claim  that  occasionally  a  diseased  mare  will  produce  a 
healthy  foal. 

Apparent  recovery  may,  and  does,  occur  even  after  ex- 
treme emaciation,  and  when  paralysis  has  been  so  complete 
that  the  animal  could  not  rise  without  assistance. 

The  duration  of  the  disease  may  extend  from  three  months 
to  as  many  or  more  years,  and  apparent  or  real  recovery 
may  take  place  at  any  intervening  time. 

In  animals  which  have  succumbed  to  the  malady  or  been 
destroyed  in  its  last  stages,  there  is  seen,  quite  uniformly, 
an  evident  degree  of  anaemia  and  emaciation.  Distributed 
throughout  nearly  every  tissue  in  the  body,  there  is  found 
a  characteristic  yellowish  exudate  of  gelatinoid  appearance, 
especially  abundant  in  the  subcutaneous  and  intermuscular 
connective  tissue,  in  the  mesentery,  and  in  all  parts  rich  in 
connective  tissue.  Nearly  every  organ  of  the  body  partakes 
of  the  general  yellowish  tinge.  The  muscles,  especially  those 
of  the  thigh  and  croup,  are  pale  and  soft. 

The  intestines  are  pale,  and,  in  some  cases,  show  signs  of 
previous  inflammation  on  their  peritoneal  surface.  The 
mesentery  is  of  a  pale  saffron  color,  thickened  by  a  gelatin- 
ous exudate.  The  mesenteric  lymphatics  are  enlarged,  pale 
yellow  and  friable.  The  spleen  is  pale,  small,  shriveled, 
tough  and  hard.  The  liver  is  soft  and  filled  with  dark 
blood.  The  kidneys  are  usually  somewhat  enlarged,  very 
pale  and  edematous. 


762  Diseases  of  the  Genital  Orgayis 

The  genital  organs  fail  to  exhibit  the  extraordinary 
changes  one  would  expect  to  find. 

I  made  autopsies  upon  several  stallions  which  had  been  in- 
fected for  one,  two  or  more  years.  Aside  from  the  general 
changes  noted  above,  there  occurred  in  the  genitalia  of  some 
animals  gross  lesions  not  directly  attributable  to  the  dourine 
but  apparently  the  result  of  secondary  infections  which  had 
invaded  the  weakened  tissues. 

One  very  bad  case,  an  imported  French  draft  stallion, 
showed  great  enlargement  of  the  scrotum,  which  was  hard 
and  unyielding  to  the  touch.  The  skin  of  the  scrotum  was 
enormously  thickened  and  pale  yellow.  The  inguinal  glands 
of  the  right  side  were  the  seat  of  extensive  abscesses,  open- 
ing at  the  upper  part  of  the  scrotum.  A  large  abscess,  oc- 
cupying the  usual  position  of  the  testicle,  was  filled  with 
dark  yellow,  hard,  cheesy  pus,  which  had  pushed  the  gland 
from  its  place  up  into  the  inguinal  canal.  The  testicle  was 
small,  atrophied,  soft,  flabby  and  pale  yellow,  with  the  serous 
covering  firmly  adherent  at  every  part.  The  surface  of  the 
penis  offered  no  evidence  of  disease.  The  urethra  contained 
a  small  amount  of  a  dirty,  purulent  secretion;  the  lining 
membrane  was  rough,  grayish-yellow,  without  any  appear- 
ance of  ulcers.  The  seminal  vesicles  and  enlarged  portions 
of  vasa  deferentia  contained  thin,  grayish,  purulent  accumu- 
lations. The  left  testicle  was  normal  in  size,  with  coverings 
firmly  adherent  at  every  part.  No  appearance  of  ulcers  was 
found  in  the  urethra  or  upon  the  penis  of  any  of  the  several 
stallions  examined. 

Investigators  have  observed  inconstant  changes  in  the 
nervous  system,  principally  injection  of  the  coverings  of 
the  brain  and  spinal  cord,  softening  of  the  lower  part  of 
the  cord,  and  occasional  extravasation  of  fluid  into  the  ven- 
tricles of  the  brain.  Thanhoff"er  describes  extensive  degen- 
eration of  the  nuclei  of  the  nerve  cells  in  the  spinal  cord. 
The  nasal  mucous  membrane  usually  shows  catarrhal  in- 
flammation. 

Differential  Diagnosis.  Few  contagious  diseases  of  ani- 
mals have  been  so  confusedly  described  by  veterinary  writ- 
ers.    At  first  there  was  a  very  general  confusion  between 


Donrbie  763 

dourine  and  genital  horse  pox,  a  condition  which  still  con- 
tinues in  many  descriptions  of  the  malady. 

The  most  reliable  local  symptoms  for  the  diagnosis  of 
dourine  in  the  stallion  consists  of  the  doughy,  elastic  swell- 
ing of  the  prepuce,  with  varying  degrees  of  penial  paralysis, 
the  penis  hanging  somewhat  out  of  its  sheath,  usually  re- 
tained within  the  prepuce.  The  urethral  opening  is  usually 
inflamed  and  a  slight  discharge  escapes  from  it,  but  there 
is  nothing  visible  to  the  naked  eye  to  mark  this  as  differing 
from  lesions  of  these  parts  due  to  other  causes. 

Later  a  depigmentation  of  the  penis  and  prepuce  may 
occur — not  in  small  circular  spots,  as  in  genital  horse  pox, 
but  in  large,  irregular  patches,  which  gradually  spread  from 
the  periphery.  In  the  mare,  the  most  important  local  symp- 
toms for  purposes  of  diagnosis  consist  of  the  doughy,  edema- 
tous swelling  of  the  vulvar  lips,  the  enlargement  of  the 
clitoris,  the  gaping  of  the  vulva  at  its  inferior  commissure, 
and  the  depigmentation  of  the  clitoris  and  its  prepuce,  and 
of  the  skin  of  the  vulva,  perineum  and  anus. 

Once  it  is  decided  that  an  equine  venereal  disease  exists  in 
a  stud,  the  presence  or  absence  of  specific  pustules  or  vesicles 
may  serve  largely  to  differentiate  between  the  two  maladies. 
Eruptions  upon  the  external  genitals  may,  of  course,  occur 
in  dourine,  but  those  writers  who  have  mentioned  them  uni- 
formly fail  to  describe  them  in  a  manner  to  enable  one  to 
differentiate  those  of  dourine  from  those  of  genital  horse 
pox,  and,  as  a  rule,  it  might  well  be  suspected  that  such 
descriptions  are  based  upon  diagnostic  error.  In  some  cases, 
doubtless,  erosions  or  ulcers  have  appeared  as  the  result  of 
irritation  from  ichorous  discharges  or  from  the  accumula- 
tions of  filth  about  the  genitals,  accompanied  by  low  vitality 
in  the  cutaneous  tissues,  but  such  eruptions  are  devoid  of 
diagnostic  value,  and  their  relation  to  the  disease,  so  far  as 
we  know,  is  quite  secondary. 

Specific  eruptions  of  vesicles  or  pustules  upon  the  genitals 
do  not  occur.  When  abundant  and  specific  eruptions  occur 
on  the  genitals  of  the  horse,  they  indicate  genital  horse  pox, 
not  douriiie. 


764  Diseases  of  the  Genital  Orgayis 

Dourine  and  genital  horse  pox  may  readily  coexist,  caus- 
ing confusion  in  diagnosis. 

Some  writers,  in  describing  dourine,  accept  the  presence 
of  the  depigmented  areas  about  the  vulva  and  anus  as  con- 
clusive evidence  of  precedent  ulceration,  but  depigmenta- 
tion of  the  skin  does  not  necessarily  follow  vesicular  or  pust- 
ular eruptions,  nor  does  its  presence  indicate  that  eruptions 
have  occurred.  I  had  excellent  opportunity  for  observing, 
day  by  day  and  week  by  week,  the  depigmentation  of  the 
skin  of  the  vulva  and  anus  in  dourine,  and  saw  it  begin  and 
gradually  spread,  without  the  presence  of  any  visible  vesi- 
cles, papules  or  ulcers.  It  was  a  depigmentation  without 
ulceration. 

Numerous  writers  place  emphasis  upon  the  presence  of 
specific  eruptions  in  dourine,  but  fail  to  describe  their  char- 
acter, and  do  not  intimate  that  they  have  personally  ob- 
served them.  In  the  extensive  Illinois  outbreak,  among 
more  than  one  hundred  cases  of  the  disease,  no  eruptions 
were  observed,  nor  could  the  most  diligent  inquiry  among 
owners  reveal  any  history  of  such  in  any  animal.  Baldrey, 
after  an  extensive  experience  with  the  malady  in  India,  fails 
to  record  the  occurrence  of  vesicles  and  pustules. 

It  seems  to  me  that  the  apparent  differences  in  observa- 
tion and  view  in  reference  to  vesicles,  pustules  and  loss  of 
pigment  in  dourine  is  due  to  the  constant  confusion  of  the 
two  wholly  distinct  veneral  diseases  and  to  accepting  the 
erroneous  conclusion  that  depigmentation  indicates  prior 
pustular  or  vesicular  eruption. 

In  reference  to  the  alleged  occurrence  of  eruptions  it 
should  be  noted  that  the  character  of  the  micro-organism 
which  causes  dourine  is  contradictory  to  the  appearance  of 
such  lesions.  Trypanosoma,  in  general,  have  little  or  no 
tendency  to  produce  eruptions  or  suppuration,  and  it  would 
seem  unique  to  expect  that,  in  this  one  disease,  alone,  of  the 
great  group,  there  should  occur  characteristic  vesicles  or 
pustules. 

The  elliptical  swellings  or  plaques  in  the  skin  of  the  flanks, 
hips  and  other  parts  of  the  body  have  long  hold  a  high  place 
in  diagnostic  value,  but  they  do  not  always  exisl. 


Doicrhie  765 

In  the  Illinois  outbreak,  the  enlarged  and  pigmentless 
clitoris  constituted  a  noteworthy  and  highly  diagnostic 
symptom  in  the  mare,  persisting  for  at  least  two  years  after 
all  other  physical  signs  of  the  malady  had  disappeared. 

The  paresis  of  dourine  is  fairly  characteristic.  Accom- 
panied by  other  lesions  and  symptoms  it  is  pathognomonic. 
The  peculiar  jerky  movements  in  the  hind  limbs  during  pro- 
gression, and  the  knuckling  over  at  the  hind  pasterns  are 
rarely  seen  in  other  forms  of  disease. 

In  addition  there  is  the  clinical  history  of  infection  by 
coition  along  with  the  malignancy  of  the  malady. 

The  finding  of  the  tnjpafiosomum  equiperdum  in  the  blood 
of  the  animal  serves  to  establish  definitely  the  diagnosis.  In 
many  cases  it  seems  to  be  very  difficult  to  find  the  parasite. 
Consequently  this  proof  of  the  character  of  the  disease  is  not 
always  readily  produced.  More  recently  the  serological 
tests  have  been  developed  and  Mohler,  Eichhorn  and  Buck 
have  obtained  satisfactory  results  by  complement-fixation, 
using  the  surra  trypanosome  in  preparing  the  antigen.  They 
thus  secured  a  "group"  instead  of  a  species  reaction  which, 
in  the  absence  of  other  trypanosoma  in  this  country,  sufficed. 

The  mortality  from  dourine  is  very  great  and  the  loss 
amounts,  upon  the  whole,  to  far  more  than  the  total  value 
of  the  diseased  animals.  When  it  has  once  become  widely 
disseminated  in  a  breeding  district,  it  practically  suspends 
the  industry  for  a  time  because  its  character  is  so  insidious 
that  it  is  exceedingly  difficult  to  trace  in  it  all  its  ramifica- 
tions. The  mortality  among  the  affected  animals  reaches  60 
to  80  per  cent,,  which  places  it  among  the  most  fatal  of 
infectious  diseases.  Those  which  apparently  recover  do  so 
very  slowly  and  the  time  consumed  before  they  are  again 
fit  for  work  is  so  great  that  their  value  is  virtually  destroyed. 
It  is  a  question  whether  animals  once  affected  can  be  bred 
again  with  safety,  no  matter  how  completely  they  may  have 
apparently  recovered  or  how  long  a  period  may  have  elapsed. 
No  treatment  for  dourine  has  yet  been  devised  which  is 
economically  practicable  and  which  affords  proper  security 
to  the  state.     Recently  some  of  the  more  complex  arsenical 


766  Diseases  of  the  Genital  Organs 

compounds  have  given  encouraging  results  experimentally, 
but  it  is  a  question  whether  the  treated  animals  are  so  far 
recovered  that  they  are  without  menace.  In  the  Illinois 
outbreak  several  mares  apparently  made  quite  complete  re- 
coveries and  performed  satisfactory  work,  but  it  was  deemed 
essential  to  keep  them  under  close  breeding  quarantine  with 
the  constant  danger  that,  by  accident  or  design,  coitus  might 
be  permitted  to  occur  and  a  fresh  outbreak  be  started.  On 
the  whole,  it  is  more  economical  that  the  state  should  as- 
sume the  burden  and  destroy  all  affected  animals.  Until 
reliable  diagnosis  has  been  made,  breeding  should  be  sus- 
pended and  all  suspects  placed  under  quarantine  restrictions 
ample  to  prevent  sexual  contact.  This  means  a  quite  rigid 
quarantine,  frequently  extending  over  a  long  period.  The 
disease  is  entirely  too  insidious  and  dangerous  to  justify  lax 
provisions.  The  castration  of  suspected  animals  has  been 
advocated,  but  this  is  not  safe  against  error.  A  castrated 
stallion  may  copulate  with  mares.  I  have  known  a  castrated 
mare  to  be  forced  into  coitus  with  the  stallion ;  the  owner, 
unaware  that  a  prior  owner  had  had  her  castrated,  believed 
her  in  estrum.  If  a  quarantine  can  be  so  arranged  that  it 
will  fully  protect  the  public  interest  and  not  prove  an  eco- 
nomic burden,  the  apparently  recovered  animal  is  efficient 
as  a  worker  and,  aside  from  coitus,  is  without  known  danger. 

B.  Genital  Horse  Pox.     Coital  Exanthem 

Eruptive  Venereal  Disease  of  the  Horse 

Genital  horse  pox  is  a  highly  contagious  disease,  which, 
under  ordinary  conditions,  is  transmitted  by  coition  only 
and  consists  of  a  local  infection  of  the  genital  organs.  It  is 
far  more  readily  transmitted  than  dourine  and  has  a  shorter 
period  of  incubation. 

Si/mptoms.  After  a  period  of  two  to  five  days  subsequent 
to  exposure,  there  appears  in  the  mare  an  iiiliammation  of 
the  mucous  membrane  of  the  vulva  and  vagina,  in  which 
there  arise  small  reddish  papules,  which  soon  become  vesi- 
cular or  pustular  and  rupture,  leaving  small  erosions  on  the 
mucosa.     From  the  vulva  there  occurs  a  more  or  less  c-oj)- 


Eruptive  Venereal  Disease  of  the  Horse  767 

ious,  muco-purulent  discharge,  which  soils  the  tail  and 
neighboring  parts.  Urination  is  somewhat  frequent  and 
the  contact  of  the  urine  with  the  denuded  mucosa  irritates 
that  membrane  and  causes  straining. 

At  the  same  time,  similar  eruptions  appear  upon  the  ex- 
ternal surface  of  the  vulva,  anus,  perineum  and  surrounding 
parts.  They  behave  somewhat  similarly  to  the  eruptions 
within  the  vulva  and  vagina.  At  first,  a  small  papule  arises 
in  the  skin,  which  soon  becomes  vesicular  and  then  pustular 
and  yellowish  white.  These  mature  quickly  and  soon  rup- 
ture, to  be  followed  by  tough,  yellow  scabs,  1/8  to  3/16  inch 
in  diameter.  After  a  few  days,  the  crusts  drop  off,  leaving 
behind  white  scars  very  slightly  depressed.  These  depig- 
mented spots  are  circular  in  form  and,  in  very  severe  cases, 
may  coalesce  somewhat.  They  tend,  however,  to  remain  dis- 
tinct circular  spots.  The  pigment  returns  after  two  or  three 
weeks,  and  no  visible  scar  remains.  The  vesicles  appear  in 
continuous  crops  over  a  period  of  one  to  three  weeks,  so  that, 
at  a  given  examination,  there  may  be  eruptions  in  every 
stage. 

Accompanying  these  eruptions,  there  is  a  swelling  of  the 
vulva,  with  some  tenderness  of  the  parts.  Some  writers 
have  described  also  a  prurigo  or  intense  itching  of  the  parts, 
causing  the  animal  to  rub  violently  the  tail  and  vulva.  Al- 
though I  have  observed  a  number  of  outbreaks,  I  have  not 
seen  this  symptom.  Neither  have  I  been  able  to  find  in  the 
literature  upon  the  subject  any  case  where  such  a  symptom 
has  been  recorded  as  a  personal  observation. 

In  the  stallion,  the  symptoms  are  virtually  the  same. 
Eruptions,  of  the  same  character  as  those  described  upon 
the  vulva  and  anus  of  the  mare,  appear  upon  the  penis,  pre- 
puce and  sheath.  The  opening  of  the  urethra  is  swollen  and 
congested  and  from  it  there  is  a  muco-purulent  discharge. 
There  is  some  swelling  of  the  prepuce  and  possibly,  to  a 
less  degree,  of  the  penis.  Ordinarily,  there  are  no  constitu- 
tional symptoms  in  either  sex,  there  is  no  loss  of  appetite 
nor  appreciable  emaciation,  and  the  general  condition  of  the 
animal  remains  undisturbed.     I  saw  one  case  in  which  fol- 


jSS  Diseases  of  the  Geriital  Orgayis 

lowing  alleged  genital  horse  pox,  there  remained  a  year 
afterward  a  severe  chronic  inflammation  of  the  vagina  and 
bladder,  which  virtually  ruined  the  animal.  In  this  case, 
the  mucous  membrane  of  the  vulva  and  vagina  was  greatly 
thickened,  corrugated,  sensitive  and  bled  easily  upon  touch. 
The  bladder  was  highly  inflamed  and  its  mucosa  greatly 
thickened,  the  urinary  salts  were  deposited  over  its  inner 
surface,  and  its  cavity  was  largely  obliterated.  The  meatus 
urinarius  was  open  and  the  urine  dribbled  away  involun- 
tarily, so  that  the  tail  and  thighs  were  kept  constantly  be- 
fouled and  presented  a  very  repulsive  appearance. 

The  course  of  the  disease  is  usually  mild  and  brief.  Most 
cases  recover  spontaneously  in  from  two  to  three  weeks  and, 
under  proper  handling,  recovery  is  hastened  and  rendered 
increasingly  certain. 

The  nature  of  the  disease  is  not  precisely  known.  A 
given  outbreak  is  not  usually  traceable  to  any  definite  source 
of  origin.  The  disease  seems  to  become  established  in  a  com- 
munity without  having  been  imported  by  a  diseased  animal. 
Once  it  becomes  established,  almost  every  mare  bred  to  an 
affected  stallion  contracts  the  disease  with  great  uniformity. 
Presumably  it  is  just  as  transmissible  to  the  stallion,  but 
this  is  not  so  often  observed,  since  the  mares  are  not  usually 
bred  to  different  males  during  the  same  season.  Experi- 
ments have  shown  that  the  vesicles  and  pustules  contain  the 
element  of  contagion  in  a  virulent  form. 

Handling.  The  handling  of  the  disease  depends  essen- 
tially upon  a  temporary  cessation  of  breeding  and  upon  dis- 
infection. Any  disinfectant  will  answer  the  purpose,  but  it 
should  not  be  highly  irritant,  since  the  parts  involved  are 
very  sensitive. 

The  handling  of  the  stallion  is  most  urgent,  so  that  he  may 
resume  service  as  promptly  and  safely  as  possible.  I  have 
come  to  prefer  an  antiseptic  wash  composed  of  1  ounce  of 
carbolic  acid  with  2  ounces  of  tannin  and  6  ounces  of  gly- 
cerine in  1  gallon  of  warm  water.  After  washing  the  penis 
and  prepuce  thoroughly  with  soap  and  water,  this  sohition 
is  applied  freely  twice  daily  and  a  quantity  of  it  is  inject od 
up  the  urethra  until  it  is  supposed  to  reach  nearly  to  the 
bladder. 


Eruptive  Venereal  Disease  of  the  Horse  769 

The  extent  of  disease  in  the  urethra  has  not  been  investi- 
gated. It  is  only  known  that  there  is  a  urethral  inflamma- 
tion and  dicharge  and  that  it  is  infective.  The  mere  wash- 
ing of  the  penis  and  prepuce  can  not,  therefore,  bring  about 
effective  disinfection,  but  the  urethra  needs  be  included. 
The  urethral  injection  is  best  made  by  means  of  a  hospital 
irrigator  with  a  small  rubber  horse  catheter  attached.  The 
end  of  the  catheter  is  inserted  into  the  urethral  opening  and 
retained  there  while  the  antiseptic  solution  is  forced  upward 
by  gravity  as  far  as  is  deemed  necessary.  Should  some  of 
the  fluid  reach  the  bladder,  it  will  not  prove  dangerous,  but 
it  is  well  not  to  overfill  the  urethral  passage,  lest  the  infec- 
tive discharges  be  forced  up  into  the  bladder.  The  external 
ulcers  resulting  from  the  pustules  may  be  touched  lightly 
with  stick  nitrate  of  silver.  The  animal  needs  be  kept  as 
free  as  possible  from  sexual  excitement,  but  should  be  given 
gentle  exercise,  along  with  a  restricted,  laxative  diet.  The 
stallion  may  be  returned  to  the  stud  as  soon  as  all  evidences 
of  disease  have  disappeared  but  it  is  advisable  to  continue 
the  disinfection,  especially  after  each  service. 

The  handling  of  the  mare  should  be  along  the  same  gen- 
eral line  and  should  be  persevered  in  until  all  symptoms 
have  disappeared.  As  a  general  rule,  she  will  recover  suffi- 
ciently during  the  interval  between  two  estrual  periods  that 
she  may  again  be  bred  at  the  first  return  of  estrum  since  the 
contraction  of  the  disease,  should  she  not  prove  to  be  in  foal. 

The  diff"erentiation  of  this  affection  from  dourine  is  highly 
important,  but  has  already  been  discussed. 

There  is  little  need  for  police  control,  since  the  symptoms 
are  so  prominent  that  laymen  promptly  note  it  and  volun- 
tarily withdraw  the  affected  animals  from  breeding  until 
recovery  has  occurred.  Should  there  at  any  time  be  a  ten- 
dency to  negligence  the  affected  animals  should  be  promptly 
quarantined  until  all  danger  has  passed. 


49 


CHAPTER  XXII 

NON-VENEREAL  SPECIFIC  INFECTIONS  WHICH 
INVADE  THE  CENITAL  ORGANS  OF  HORSES 

A.  Contagious  Cellulitis.     Epizootic  Cellulitis.  Pink  Eye. 
Rheumatic  Influenza.     Muco-Enteritis 

Bibliography.  Williams.  Epizoutic  Cellulitis,  Principles  and  Practice  of  V'eterinarv  Med- 
icine. 4th  edition.  1888.  p.  251.  Cave.  Pink  Eve.  Veterinary  Journal.  1883.  Vol.  XVI.  p.  336. 
Whitworth.  Pink  Eye  Disease,  ibid.,  1883,  Vol.  XVII.  p.  153.  Pottie,  Jour.  Comp.  Path,  and 
Therap..  Vol.  I.  p.  37.  Clark,  ibid..  Vol.  V.  p.  261.  Reeks.  The  Transmission  of  Pink  Eye 
from  apparently  Healthy  Stallions  to  Mares,  ibid..  Vol.  XIV,  p.  159,  and  Vol.  XV,  p.  97. 

Contagious  Cellulitis  is  a  highly  contagious  acute  fever  of 
the  horse,  which  has  been  generally  ignored  except  by  Brit- 
ish veterinary  writers,  although  it  seems  to  be  widely  dis- 
tributed in  various  countries.  It  is  common  in  parts  of 
America,  but  frequently  confused  with  influenza  or  catarrhal 
fever. 

A  description  of  the  disease  is  inserted  here  because  of  its 
intimate  bearing  upon  the  question  of  horse  breeding,  which 
it  aff"ects  chiefly  in  three  distinct  ways. 

Frequently  it  spreads  from  apparently  healthy  stallions 
to  mares  through  copulation,  in  which  respect  it  approaches 
the  character  of  a  venereal  disease,  but  as  a  general  rule 
this  is  not  the  method  by  which  it  is  transmitted  from  ani- 
mal to  animal. 

It  has  a  relation  to  sterility  because  it  causes  an  orchitis 
in  the  stallion  which  frequently  leads  to  a  permanent  loss  of 
function  in  these  glands. 

Contagious  cellulitis  is  commonly  associated  with  abortion 
in  pregnant  mares.  The  manner  in  which  abortion  is  caused 
by  the  disease  is  unknown.  Since  the  bacteriology  is  un- 
known, it  can  not  be  stated  that  the  infection  does  or  does 
not  enter  the  uterus  or  the  fetus  and  bring  about  disaster. 
The  probabilities  are  that  the  infection  reduces  the  vitality 
of  the  pregnant  mare  and  enables  those  bacteria  which  exist 
within  the  uterus  to  multiply  rapidly  and  cause  abortion. 

Sj/niptonis.  The  symptoms  of  the  disease  consist  primarily 
of  an  ck'Nation  of  temperature,  sonu'tinies  acconipanied  hv 


Contagious  Cellulitis.     Epizootic  Cellulitis  771 

chills,  dullness  and  other  phenomena,  which  belong  in  gen- 
eral to  acute  contagious  fevers.  The  fever  appears  very  sud- 
denly, usually  ranging  from  103  to  105'  F.  although  it  may 
exceed  this.  Generally  speaking,  the  tem.perature  is  higher 
than  in  influenza  and  lower  than  in  the  contagious  pneu- 
monia of  the  horse.  The  pulse  is  hard  and  full  and  some- 
what quickened;  respiration  is  not  very  greatly  disturbed. 
Cough  is  present,  though  this  does  not  constitute  a  very 
prominent  symptom  of  the  affection. 

Early  in  the  disease  there  is  a  manifestation  of  pain  in  the 
limbs,  which  is  shown  by  shifting  of  the  weight  from  one 
foot  to  another  while  the  animal  is  standing  and  by  great 
stiffness  and  soreness  when  forced  to  move,  the  movements 
being  accompanied  by  a  cracking  sound  in  the  joints.  After 
a  time  the  legs  begin  to  swell,  commencing  at  the  feet  and 
extending  upward  until  at  times  the  body  is  affected.  This 
tumefaction  has  its  chief  seat  in  the  subcutaneous  connective 
tissue  and  is  at  times  very  great.  As  the  swelling  of  the 
limbs  increases,  the  pain  in  them  tends  to  abate  and  at  the 
same  time  the  fever  begins  to  decrease. 

The  alimentary  tract  is  greatly  disturbed.  At  first  there 
is  a  very  marked  tendency  to  constipation,  in  which  the  feces 
are  covered  with  large  quantities  of  mucus  and  their  color 
considerably  altered.  Defecation  causes  some  pain  and 
straining.  Later  there  is  a  tendency  to  diarrhea,  which  is 
easily  and  often  fatally  intensified  by  the  administration  of 
purgatives,  especially  of  aloes.  The  conjunctiva  becomes 
bright  pink,  swollen  and  edematous.  At  times  the  conjunc- 
tivae are  so  badly  swollen  that  the  eyelids  become  somewhat 
everted  and  the  edematous  membrane  pushed  out  between 
them.  The  eyes  are  very  sensitive  to  light  and  the  animal 
attempts  to  keep  them  closed.  There  is  a  profuse  secretion 
of  tears,  which  flow  down  over  the  cheeks.  The  cornea  is 
frequently  clouded,  so  that  vision  may  for  a  time  be  inter- 
rupted. There  is  some  tendency  toward  pleurisy,  pneumonia 
and  other  pulmonaiy  complications. 

From  a  breeding  standpoint,  the  chief  interest  lies  in  the 
complications  of  the  genital  organs.    The  breeding  stallion 


772  Diseases  of  the  Genital  Organs 

shows  a  great  tendency  to  suffer  from  orchitis.  I  have  seen 
in  large  importing  stables  50  to  75  per  cent,  of  the  stallions 
attacked  with  pink  eye  suffering  from  inflammation  of  the 
testicles.  Along  with  the  swelling  of  the  scrotum  and 
sheath,  which  accompanies  that  of  the  legs,  there  usually 
appears  a  tense,  painful  enlargement  of  the  testicles,  which 
tends  to  persist  for  a  considerable  period  after  the  general 
symptoms  of  the  disease  have  largely  disappeared.  In  some 
instances  permanent  sterility  results.  In  other  cases,  stal- 
lions which  have  apparently  recovered  from  the  disease  have 
quite  uniformly  transmitted  it,  during  copulation,  to  sus- 
ceptible mares.  These  observations  are  entirely  in  harmony 
with  those  of  Reeks,  who  records  an  instance  where  an  ap- 
parently sound  stallion  transmitted  the  disease  to  suscepti- 
ble mares  almost  uniformly  over  a  period  of  two  years. 

It  is  notable  also  that,  when  the  disease  attacks  a  preg- 
nant mare,  it  generally  causes  abortion  or,  if  attacking  her 
just  prior  to  parturition,  the  living  foal  is  likely  to  succumb 
within  a  few  days  after  birth.  Reeks,  recording  an  outbreak 
under  his  charge,  relates  that  four  pregnant  mares,  or  mares 
which  had  just  foaled,  contracted  the  disease.  Two  of  the 
pregnant  mares  aborted,  and  the  foals  of  the  other  two  died 
suddenly  shortly  after  birth. 

Although  highly  contagious,  the  affection  is  of  short  dura- 
tion ;  usually  runs  a  favorable  course,  except  in  those  ani- 
mals used  for  breeding  purposes,  in  from  four  to  six  days ; 
and  leaves  the  animal  but  little  altered. 

No  specific  treatment  has  been  discovered.  The  greatest 
benefit  is  to  be  derived  from  the  administration  of  diffusible 
stimulants,  such  as  nitrous  ether  or  carbonate  of  ammonia, 
along  with  quinine.  Purgatives  are  to  be  avoided.  Aloes 
is  especially  dangerous.  The  bland  oils  might  be  used  in 
some  cases  as  aperients,  or  very  small  doses  of  eserine,  are- 
coline  or  other  alkaloid  hypodermic  cathartic,  taking  care  to 
make  the  dose  sutliciently  small  to  induce  no  harmful  degree 
of  excitement  and  barely  sufficient  to  cause  gentle  purga- 
tion. There  is  naturally  much  divergence  of  opinion  among 
veterinarians  in  reference  to  the  treatment  of  this  affection, 
but  its  general  handling  is  not  of  special  interest  here. 


Contagions  Cellulitis.     Epizootic  Cclhilitis  773 

When  the  disease  appears  in  a  breeding  area  it  should  be 
handled  with  the  greatest  rigor  as  to  quarantine,  and  the 
breeding  quarters  should  receive  special  consideration.  Dis- 
eased mares  or  mares  coming  from  infected  premises  should 
on  no  account  be  admitted  to  the  breeding  place.  Should 
the  malady  become  general  in  a  neighborhood,  as  it  usually 
does  when  an  outbreak  occurs,  breeding  should  be  suspended 
until  the  disease  disappears. 

When  a  breeding  stallion  has  become  infected,  aside  from 
the  general  handling  of  the  malady,  special  attention  should 
be  given  to  reducing  to  a  minimum  the  dangers  from  orchitis 
and  later,  after  the  acute  symptoms  have  passed,  to  over- 
coming the  lingering  chronic  infection,  through  which  he 
may  continue  to  spread  the  disease  to  mares. 

When  it  is  known  that  a  non-immune  breeding  stallion  has 
been  exposed  to  this  disease,  immediate  precautions  should 
be  taken  to  guard  the  animal  against  a  severe  attack.  He 
should  be  placed  at  rest,  physically  and  sexually.  The  usual 
high  feeding  of  breeding  stallions  should  at  once  be  dis- 
placed by  a  very  light  laxative  diet,  such  as  grass,  roots  and 
bran,  with  an  abundance  of  salt.  If  these  measures  do  not 
induce  a  prompt  unloading  of  the  alimentary  tract,  the  bow- 
els should  be  evacuated  by  means  of  small  doses  of  eserine 
or  arecoline  and  the  system  placed  in  first-class  condition  to 
withstand  the  onset  of  the  disease.  Pending  the  advent  of 
the  disease,  the  animal  should  have  regular  daily  exercise, 
though  great  care  should  be  taken  not  to  continue  it  after 
the  appearance  of  the  first  symptom  of  the  malady,  fever, 
has  become  established,  as  indicated  by  thermometry.  If 
the  stallion  is  attacked  without  these  precautions  having 
been  taken,  similar  measures  should  still  be  adopted.  The 
ration  should  be  reduced  and  confined  to  laxative  foods,  and 
the  bowels  should  be  promptly  and  cautiously  evacuated. 

The  stallion  is  to  be  guarded  against  physical  or  sexual 
excitement.  Strange  mares  should  not  be  allowed  in  sight 
or  hearing,  and  every  precaution  should  be  taken  against 
arousing  sexual  desire.  In  most  stallions  the  application  of 
the  stud  bridle  occasions  excitement,  which,  at  such  times, 
should  be  avoided. 


774  Diseases  of  the  Genital  Organs 

If  orchitis  appears,  as  it  frequently  does,  in  addition  to 
the  foregoing  measures,  including  the  internal  administra- 
tion of  nitrous  ether  and  quinine,  local  applications  to  con- 
trol the  inflammation  in  the  glands  should  be  applied.  First 
among  these  in  the  early  stages  is  local  refrigeration  by  the 
application  of  cold  water  or  ice.  Probably  the  most  efficient 
means  is  the  application  of  broken  ice  by  means  of  a  suspen- 
sorium,  which  serves  the  double  purpose  of  refrigeration 
and  supporting  the  weight  of  the  pendant  glands.  This  treat- 
ment should  be  constantly  and  faithfully  applied  until  the 
crisis  of  the  malady  has  passed,  since  the  effective  handling 
of  these  glands  may  determine  whether  the  animal  is  to  be 
of  further  value  as  a  breeder.  Such  remedies  as  belladonna 
and  camphor,  applied  locally,  tend  to  relieve  congestion  and 
overcome  the  inflammation,  but  in  a  critical  case  the  refrig- 
eration is  probably  superior. 

Later,  when  the  acute  symptoms  have  passed,  chronic  in- 
fection should  be  considered,  precautions  taken  against  the 
spread  of  the  malady  to  mares,  and  measures  adopted  to 
eradicate  the  infection  from  the  system  as  quickly  as  possi- 
ble. For  this  purpose  an  extended  course  of  potassium 
iodide  at  the  rate  of  Vo  ounce  per  day  for  each  1,000  lbs.  of 
body  weight  is  probably  the  safest  remedy.  Some  veteri- 
narians fear  that  the  prolonged  administration  of  this  drug 
may  induce  a  harmful  atrophy  of  the  testicles,  but  this  is 
quite  imaginary  and  without  foundation.  The  iodide  should 
be  continued  for  three  or  four  weeks,  or  longer  if  necessary. 

Abundant  time  should  be  allowed  to  elapse,  after  the  dis- 
appearance of  all  visible  symptoms  of  the  disease,  before 
permitting  the  animal  to  serve  mares.  It  is  advisable,  in 
case  the  disease  attacks  the  stallion  during  the  breeding  sea- 
son, to  withdraw  him  from  the  stud  for  the  year.  In  any 
case  it  is  wise  to  begin  breeding  cautiously  and  watch  closely 
for  evidences  of  the  transmission  of  the  infection  to  suscep- 
tible mares.  When  a  stallion  which  has  sufl"ered  from  pink 
eye  shows  evidences  of  sterility,  careful  examination  of  the 
genitals  and  of  the  semen  should  be  made  and.  should  any 
restoration  of  the  breeding  powers  seem  iK)ssil)l(>.  appi-opi'i- 


Bursattcc  of  the  Penis  and  Prepuce  775 

ate  measures  undertaken,  but  usually  the  sterility  is  per- 
manent and  irremediable  and  the  animal  must  be  removed 
from  the  stud  and,  with  or  without  castration,  used  for 
work. 

B.    Bursattee  of  the  Penis  and  Prepuce 

Genital  bursattee  presents  characters  suggesting,  to  the 
inexperienced,  a  venereal  disorder,  and  constitutes  an  an- 
noying disease  in  breeding  stallions.  It  is  not  infrequent 
in  those  countries  where  this  malady  prevails  in  other  por- 
tions of  the  body.  Bursattee  shows  a  distinct  tendency  to 
attack  the  penis  and  prepuce  of  breeding  stallions,  especially 
of  heavy  draft  animals.  Presumably  the  infection  is  not 
coital  but  is  transmitted  by  other  means — accidental  wounds, 
flies  or  other  carriers. 

The  usual  symptom  of  penial  bursattee,  when  first  ob- 
served by  the  groom  or  owner,  is  the  presence  about  the 
urethral  opening  of  an  angry-looking  fungoid  growth,  which 
bleeds  upon  the  slightest  touch  and  is  generally  observed  to 
bleed  immediately  after  coition.  Sometimes  during  erec- 
tion blood  drips  from  the  tumor.  Another  fungoid  mass  of 
similar  appearance  exists  at  the  preputial  ring  upon  the  in- 
ferior or  urethral  side  near  the  middle  of  the  organ  when 
erected — that  point  where  the  urethral  opening  rests  when 
the  penis  is  fully  withdrawn  within  its  prepuce  and  sheath. 
When  the  penis  is  at  rest,  therefore,  the  growths  about  the 
urethral  opening  and  on  the  preputial  ring  are  in  immediate 
contact :  the  preputial  growth  has  emanated  from  that  about 
the  urethral  opening,  as  a  consequence  of  contact. 

The  bursattic  growth  may  begin  at  other  points  or  may 
extend  from  the  seat  of  infection  to  neighboring  parts.  In 
one  instance,  I  observed  the  disease  beginning  upon  the 
scrotum. 

If  the  new  growth  is  closely  inspected,  it  is  usually  possi- 
ble to  recognize  readily  with  the  naked  eye  the  small  yellow 
concretions  or  "kunkurs"  characteristic  of  the  malady.  In 
some  cases  penial  bursattee  is  accompanied .  by  infections 
upon  the  feet  or  other  parts. 


776  Diseases  of  the  Genital  Organs 

I  have  not  seen  the  disease  transmitted  to  mares  through 
copulation,  though,  clinically,  it  behaves  as  an  infectious 
malady  and  possibly  there  is  danger  of  transmission  to  the 
mare  through  the  vagina. 

The  micro-biology  of  the  disease  has  not  been  fully  de- 
termined :  some  attribute  it  to  mematode  worms ;  others  to 
the  presence  of  a  fungus. 

Like  bursattee  of  other  parts,  it  is  active  in  temperate 
countries  only  during  the  hot  season  and  undergoes  ap- 
parent spontaneous  recovery  upon  the  advent  of  winter,  to 
remain  dormant  until  the  return  of  warm  weather.  Thus 
it  incidentally  assumes  its  greatest  activity  during  the 
breeding  season  and  interferes  seriously  with  stud  duties. 
Aside  from  the  remote  possibility  of  transmission,  it  is 
very  noticeable,  and  owners  of  mares  naturally  do  not  care 
to  breed  them  to  a  stallion  so  evidently  diseased.  Further- 
more, the  sexual  excitement  incidental  to  breeding  greatly 
influences  the  disease  and  adds  to  its  virulence :  each  erec- 
tion of  the  penis,  with  the  consequent  congestion  of  the  or- 
gan, causes  the  bursattee  growth  to  bleed. 

The  handling  of  the  disease  consists  of  the  destruction  or 
removal  of  all  infected  tissues  and  the  avoidance  of  venereal 
excitement.  If  undertaken  early,  the  disease  is  usually  con- 
fined to  the  urethral  tube,  filling  it  and  protruding  beyond 
the  navicular  fossa,  and  may  extend  up  higher  in  the  ure- 
thra. Whatever  the  extent,  the  diseased  tissues  are  to  be 
excised  or  curetted  away  and  the  parts  well  cauterized  with 
silver  nitrate  or  the  thermocautery,  after  which  the  wound 
may  be  dressed  with  iodoform,  which  apparently  exerts  a 
very  beneficial  influence  upon  the  course  of  the  disease, 
should  any  infection  remain.  Care  is  to  be  taken  not  to  de- 
nude unnecessarily  the  urethral  meatus  of  its  entire  mucosa, 
since  urethral  stricture  may  result,  necessitating  penial  am- 
putation. If  the  pathologic  growth  involves  the  entire  cir- 
cumference of  the  meatus,  the  risk  of  stricture  must  be 
deliberately  faced  with  the  assurance  that,  if  stricture  fol- 
lows, amputation  may  be  made  without  interfering  with  the 
breeding  value  of  the  stallion.  The  method  of  amputation 
has  already  been  described. 


Bursattee  of  the  Penis  and  Prepuce  777 

Before  operating,  it  is  well  to  apply  local  anaesthesia, 
though  the  sensitiveness  of  the  part  is  not  marked,  as  is 
usually  the  case  with  bursattic  growths.  Successful  han- 
dling demands  the  withdrawal  of  the  animal  from  the  stud 
and  the  prevention  of  sexual  excitement.  If  necessary, 
erection  of  the  penis  should  be  prevented  by  the  application 
of  a  stallion  guard. 

At  the  preputial  ring,  at  that  point  where  the  opening  of 
the  urethral  tube  rests  when  the  penis  is  completely  with- 
drawn, the  secondary  bursattic  growth  is  more  amenable  to 
management.  Here  the  operator  can  freely  excise  the  dis- 
eased tissue  without  danger  of  unpleasant  deformity. 

After  excision  or  destruction  of  the  diseased  tissues,  the 
parts  should  be  kept  scrupulously  clean.  It  is  advisable  to 
wash  the  penis,  prepuce  and  sheath  twice  daily  with  soap 
and  water,  to  which  one-half  to  one  per  cent,  of  carbolic 
acid  may  be  added.  After  cleansing,  the  parts  may  be 
dressed  with  powdered  iodoform,  or  iodoform  ointment. 
Before  applying  the  iodoform,  any  suspicious  areas  may  be 
cauterized  with  stick  nitrate  of  silver. 


CHAPTER  XXIII 

THE  GENERAL  INFECTIONS  OF  THE  GENITALIA 
OF  HORSES 

The  general  infections  of  the  genital  organs  of  horses  are 
quite  analogous  to  those  of  cattle.  Apparently  most  bacteria 
which  are  capable  of  acquiring  a  habitat  in  the  genitalia  of 
cattle  may  do  so  in  horses.  Those  who  believe  in  a  specific 
''contagious  abortion"  for  cows  and  another  for  mares  claim 
that  the  organism  of  "contagious  abortion"  in  the  cow  will 
cause  abortion  in  the  mare,  and  vice  versa.  They  further 
claim  that  the  organisms  causing  abortion  in  each  of  these 
are  potent  to  cause  abortion  in  ewes,  sows,  bitches,  rabbits, 
guinea  pigs,  etc.  They  have  shown  quite  conclusively  that 
the  organisms  are  able  to  acquire  a  habitat  in  numerous 
domestic  and  experiment  animals.  How  frequently  the 
alleged  abortion-producing  organisms  naturally  acquire  a 
habitat  in  the  uteri  of  species  other  than  that  in  which  they 
are  alleged  to  be  the  cause  of  abortion  is  wholly  unknown, 
all  recorded  observations  being  predicated  upon  studies  of 
those  animals  which  had  been  experimentally  inoculated 
with  the  infection. 

The  subject  of  "contagious  abortion"  as  a  specific  disease 
in  cattle  has  been  discussed  at  length  and  any  attempt  to 
discuss  "contagious  abortion"  of  mares  would  be  an  unwar- 
ranted repetition.  The  evidences  regarding  the  existence  of 
such  specific  disease  in  the  mare  are  the  same  in  principle, 
but  less  voluminous  than  in  the  cow.  Investigators  claim 
to  have  proven  the  existence  of  such  specific  disease  in 
mares  and  to  have  identified  clearly  the  causative  organism, 
but,  as  in  the  cow,  they  have  ignored  the  two  most  basic 
principles  in  the  experimental  production  of  disease — they 
have  submitted  no  evidence  of  the  freedom  of  the  experi- 
ment animal  from  the  infection  when  the  experiment  was 
begun,  and  no  controls  were  kept.  The  genital  organs  of 
horses  offer  analogous  diseases  throughout,  modified  by  im- 
portant variations  in  their  anatomy. 


General  Infections  of  the  Crenitalia  of  Horses  779 

The  clinical  examination  of  the  genitalia  of  both 
sexes  of  horses  is  essentially  the  same  as  in  the  cow. 
The  stallion  offers  differences  in  the  size  and  form  of  the 
seminal  vesicles.  The  act  of  coitus  is  more  prolonged.  The 
collection  of  semen  for  examination  is  more  readily  ob- 
tained through  the  larger  vulva  of  the  mare.  The  semen 
may  be  obtained  without  vaginal  contamination  by  the  use 
of  a  rubber  bag  upon  the  penis.  In  other  particulars  the 
examination  of  the  genitalia,  the  semen  and  the  spermatozoa 
is  the  same  as  for  the  bull. 

The  ovaries  of  the  mare  lie  far  forward,  but  are  easily 
within  reach  and  readily  palpated  per  rectum.  The  cervix 
is  short  and  its  canal  very  dilatable,  rendering  the  uterine 
cavity  more  readily  examined. 

While  describing  the  general  infections  of  bulls,  it  was 
pointed  out  that,  in  the  absence  of  definite  general  lesions 
recognizable  by  physical  examination,  there  may  and  do  ex- 
ist in  the  testicles,  epididymis  and  seminal  bladder  infec- 
tions which  are  ejaculated  in  the  semen  and  carry  serious 
peril,  causing  extensive  genital  disease  of  the  cow  and  re- 
sulting in  much  sterility  and  abortion.  In  discussing  con- 
tagious cellulitis  of  horses  it  has  also  been  pointed  out  that 
the  infection  may  be  transmitted  to  the  mare  by  the  stallion 
during  coitus. 

In  polygamous  reproduction  the  male  is  necessarily  the 
chief  factor  in  the  transmission  of  genital  infections,  in 
part  because  he  comes  in  sex  contact  with  numerous  females, 
while  the  female  ordinarily  has  coitus  with  but  a  single 
male.  The  male  is  a  further  peril  in  sex  infection  because 
in  polygamous  reproduction  he  is  placed  under  more  severe 
sex  strain,  rendering  existing  infections  in  his  genitalia 
more  virulent.  Schofield'  found  that  abortion  in  mares  was 
chiefly  observed  in  those  which  had  been  bred  to  certain 
stallions.  It  was  further  noted  by  Schofield  that  the  foals, 
born  of  mares  bred  to  stallions  whose  mares  largely  aborted, 
frequently  suffered  from  arthritis.     It  was  thus  shown  in 

'  Investiijation  into  Equine  Abortion.    F.  W.  vScliofield,  Ontario  \'et    Col 
1915- 


'/So  Diseases  of  the  Genital  Organs 

his  observations  that  the  stallion  transmitted  an  infection 
which  led  in  many  cases  to  abortion  some  months  later  and 
which  in  other  cases  persisted  throughout  the  span  of  intra- 
uterine life  and  continued  in  the  foal  after  birth.  This  is  in 
harmony  with  my  observations.  Nevertheless  some  stal- 
lions showing  no  genital  lesions  clinically  are  frequently 
highly  infectious.  According  to  the  intensity  of  the  infec- 
tion, there  follows  death  of  the  spermatozoa,  ova,  fertilized 
ova  or  small  embryo  (sterility),  metritis  with  death  and 
observed  expulsion  of  the  fetus  (abortion),  or  puerperal 
metritis  and  retained  fetal  membranes  in  the  mare,  and 
arthritis,  dysentery  or  other  disease  of  the  foal. 

The  general  infections  of  the  genitalia  of  horses  conform, 
therefore,  so  far  as  can  now  be  seen,  to  those  of  cattle  and, 
what  is  more  important,  conform  to  the  fundamental  laws 
of  general  genital  infections  in  all  mammalia.  Among  the 
genital  infections  of  mammals,  certain  specific  diseases  ex- 
ist, such  as  syphilis,  dourine,  canine  venereal  tumors,  chan- 
croid or  vesicular  venereal  diseases  of  man,  horses  and  cattle, 
gonorrhea  and  others  which  involve  largely  or  exclusively 
one  species  of  animal,  producing  specific  lesions  which  serve 
to  differentiate  clinically  the  infection  from  all  others. 

There  are  other  infections  which  invade  the  genitalia  of 
all  mammals,  each  of  which  may  and  do  exist  in  the  genitalia 
of  several  species  of  animals.  They  do  not  necessarily  cause 
visible  harm  but,  when  intensified  by  bad  physical  or  sexual 
hygiene,  may  attain  high  virulence  and  produce  a  great  va- 
riety of  lesions.  They  may  invade  and  interfere  with  the 
function  of  any  organ  or  tissue  in  the  genital  system  of 
either  sex  of  any  age.  The  invasion  is  not  necessarily  direct 
through  the  genital  tract.  The  fetus  swallows  the  infection, 
derived  from  the  uterus  of  the  mother,  with  its  amniotic 
fluid.  Again  the  new-born  swallows  any  infection  emanat- 
ing from  the  uterus  which  may  flow  down  the  tail  or  thighs 
and  reach  the  exterior  of  the  teats.  In  many  cases  the  in- 
fection enters  the  body  of  the  new-born  through  the  navel 
wound,  in  which  case  arthritis  becomes  the  outstanding 
clinical  phenomenon.     But  the  arthritis  of  navel  infection 


General  Infections  of  the  Genitalia  of  Horses  78  r 

except  in  some  cases  for  the  navel  lesions  themselves,  is  not 
clinically  nor  bacteriologically  differentiable  from  the  arth- 
ritis caused  by  the  fetus  swallowing  the  infection  emanat- 
ing from  the  utero-chorionic  space,  or  by  the  new-born  swal- 
lowing infection  in  its  food. 

Unlike  the  specific  venereal  diseases  mentioned,  the  gen- 
eral infections  are  commonly  present  in  the  genital  organs 
and  elsewhere,  their  number  is  unknown,  and  their  lesions 
are  alike.  The  lesions  in  the  uterus  and  fetus  attributed  to 
the  B.  abortus  (Bang)  can  not  be  distinguished  from  those 
of  the  spirillum  of  Smith,  the  bacillus  of  Moussu,  or  the 
B.  abortivo-equinus  of  Good.  Each  of  these  is  believed  to  be 
capable  of  living  and  multiplying  in  the  genital  organs  of 
an  extended  list  of  mammals. 

As  in  bulls,  when  genital  infections  in  stallions  become 
severe  and  produce  clinically  recognizable  lesions,  they  often 
lose  their  peril  for  the  female  because  the  spermatic  ducts 
are  blocked  by  the  lesions  and  the  infection  imprisoned.  The 
infections  of  the  genitalia,  therefore,  which  are  recognizable 
only  by  a  microscopic  study  of  the  spermatozoa,  bacterial 
search  of  the  semen,  or  a  bio-histologic  study  of  the  ovaries 
or  oviducts,  are  of  far  greater  importance  economically 
than  the  more  readily  recognizable  lesions.  The  clinically 
recognizable  lesions  of  the  genitalia  of  horses  are  varied 
and  not  rare. 


I.  THE  GENERAL  GENITAL  INFECTIONS 
OF  STALLIONS 

A.  Orchitis  and  Epididymitis 

1.  Degenerative  Orchitis  and  Epididymitis  of  Colts 
Colts  sometimes  suffer  from  a  degenerative  or  desquama- 
tive orchitis  in  which  the  epididymis  participates.  The  dis- 
ease is  apparently  identical  with  that  already  described  in 
bull  calves.  It  ordinarily  passes  unobserved  up  to  breeding 
age,  when  attention  is  attracted  to  the  genitalia  by  a  total 
want  of  fertility.  Clinical  examination  reveals  small,  soft, 
flabby  testicles,  about  one-fourth  to  one-half  the  normal 
volume.  The  animal  has  normal  sexual  desire  and  copulates 
promptly,  but  no  spermatozoa  are  ejaculated.  Histologic 
examination  of  the  testicles  reveals  necrosis  and  desquama- 
tion of  the  germinal  epithelium,  with  corresponding  changes 
in  the  epididymis  and  absence  of  spermatozoa.  The  cause 
is  unknown.  Apparently  the  condition  is  dependent  upon 
the  invasion  of  the  testicles  during  the  nursing  period,  as 
appears  to  be  the  case  in  calves.  The  infection  probably  ex- 
ists in  the  alimentary  tract  of  the  foal  at  birth  and  acquires 
invasive  power  during  dysentery.  At  least  the  changes  ex- 
ist when  puberty  is  reached  and  their  character  points  to  in- 
fection as  the  cause.  Since  the  condition  is  hopeless,  the 
animal  should  be  castrated  and  used  for  work.  Prevention 
of  the  condition  lies  in  the  proper  rearing  of  young  foals, 

2.    Orchitis  and  Epididymitis  of  Adult  Stallions 

Reference  has  already  been  made  to  the  concurrence  of 
orchitis  and  epididymitis  as  a  common  complication  of  con- 
tagious cellulitis  in  stallions.  Orchitis  and  epididymitis  not 
referable  to  any  recognized  specific  infection,  is  observed 
occasionally  in  stallions.  The  clinical  evidences  of  the  dis- 
ease are  swelling  of  the  organs  with  increased  heat  and  evi- 
dent pain  upon  pressure.  The  testicle  itself  is  so  bound  down 
by  its  tunic  that  it  swells  only  slowly,  while  the  less  re- 
stricted epididymis  swells  more  rapidly.  The  line  of  demar- 
cation between  the  two  organs  (luickly  btn-onuvs   indistiiut 


Orchitis  and  Epididymitis 


783 


and  lost,  so  that  as  a  rule  the  epididymis  and  testis  can  not 
be  told  apart  clinically  in  the  presence  of  acute  inflammation. 
A  clear  differentiation  between  orchitis  and  epididymitis  is 
not  supremely  important,  each  having  essentially  like  im- 
portance for  the  reproductive  life  of  the  animal. 

According  to  the  intensity  of  the  disease,  fever  is  present 
with  loss  of  appetite  and  other  general  symptoms.  As  a  rule 
the  testicles  suffer  simultaneously  but  unequally.  The  onset 
of  the  disease  is  generally  violent,  it  continues  intense  for 


Fig.  226— Orchitis  and  Epididymitis.     Stallion. 
T,  Testicle  ;  E,  epididymis. 


784  Diseases  of  the  Genital  Organs 

several  days  or  weeks,  and  then  slowly  abates.  The  glands 
do  not  ordinarily  recover  in  volume  or  function.  The  prog- 
nosis for  the  life  of  the  animal  is  highly  favorable,  but  for 
the  reproductive  functions  is  usually  hopeless. 

As  will  be  seen  in  Figs.  226  and  227,  the  gross  changes 
consist  chiefly  in  atrophy  of  the  testicle  and  hypertrophy  of 
the  epididymis,  so  that  the  ordinary  relationship  in  volume 


Fig.  227 — Orchitis  and  Epididymitis. 

/,  Kpididymis  ;  2,  i)areiichyma  of  gland  ;   ?,  hemorrhage  in  epididymis; 
./,  hemorrliage  in  testicle. 

of  the  two  structures  becomes  reversed.  In  the  early  stages, 
as  shown  in  Fig.  227,  prominent  hemorrhage  may  occur. 
The  infection  extends  to  the  peritoneal  covering,  by  con- 
tiguity involves  the  parietal  peritoneum  of  the  scrotum,  and 
causes  adhesions  between  the  two  layers.  Histologic  and 
biologic  studies  have  not  been  made  in  sufficient  degree  to 
permit  of  any  conclusions.  The  colon-like  organism  ordi- 
narily alleged  to  cause  abortion  in  mares  may  logically  be 
considered  as  a  common  cause.     At  least  it  is  fair  to  assume 


Diseases  of  the  Seminal  Vesicles  785 

for  the  present  that  the  organism  most  commonly  causing 
abortion  in  mares  is  the  commonest  invader  of  the  testes  and 
epididymes  of  stallions.  The  disease  occurs  most  frequently 
at  the  height  of  the  breeding  season,  the  virulence  of  the  in- 
fection already  present  being  aroused  by  repeated  coitus. 

The  handling  of  orchitis  is  a  discouraging  task.  The  ani- 
mal should  be  taken  out  of  the  stud  immediately,  sexual 
excitement  avoided  as  far  as  possible,  the  patient  placed 
upon  scant,  laxative  diet,  and  as  a  rule  given  an  abundance 
of  gentle  exercise.  If  the  inflammation  is  intense,  its  course 
may  be  checked  by  purging  promptly  with  arecolin  or  eserin. 
Benefit  may  be  had  from  large  doses  of  potassium  iodide, 
about  one-half  ounce  per  thousand  pounds  of  body  weight, 
once  or  twice  daily.  In  the  first  stages  the  continuous  re- 
frigeration of  the  glands  by  means  of  a  spray  of  cold  water 
may  be  of  value.  When  the  infection  is  intense  and  has  con- 
tinued so  long  that  recovery  of  reproductive  functions  is 
impossible,  castration  should  be  performed  promptly  as  the 
best  and  safest  method  for  controlling  the  disease.  If  ap- 
parently but  one  testicle  is  involved,  it  should  be  removed 
promptly  as  the  best  protective  measure  against  the  involve- 
ment of  the  other  gland.  The  removal  of  one  gland  does  not 
lower  the  fertility. 

When  the  animal  has  apparently  recovered,  a  long  sexual 
rest  should  be  given  before  returning  him  to  stud  service. 
Then  a  test  service  should  be  made  with  a  mare  and  the 
semen  examined  for  spermatozoa  and  bacteria.  If  sound  in 
both  respects  he  may  be  permitted  to  resume  stud  service. 

3.    Diseases  of  the  Seminal  Vesicles. 
Semino- Vesiculitis 

Veterinary  literature  reveals  no  traces  of  any  compre- 
hensive study  of  the  infections  of  the  seminal  vesicles  of 
stallions.  The  studies  already  made  regarding  the  infections 
of  these  organs  in  bulls  indicate  that  generally  the  glands 
about  the  pelvic  urethra  of  the  male  are  highly  susceptible 
to  any  infections  which  may  invade  seriously  the  genitalia 
of  the  female,  and  that  the  probability  of  disease  rests  in  a 
50 


786  Diseases  of  the  Genital  Organs 

measure  upon  the  comparative  development  of  the  given 
structure.  That  is,  the  seminal  vesicles,  prostate  and  Cow- 
per's  glands  will  tend  to  become  involved  in  proportion  to 
the  functional  importance  of  each  in  the  species  under  con- 
sideration. Thus  in  the  bull  the  seminal  vesicle  is  the  most 
commonly  involved  subsidiary  sex  gland,  while  in  the  dog 
the  prostate  gland  suffers  most  frequently  and  severely. 


Fk;.  22S — Enlarged  Seminal  Vesicles.     Gelding. 
U,  Urinary  bladder  ;  .V,  .V,  seminal  vesicles. 

Since  ascending  invasions  along  the  urethro-vas  deferens 
canal  naturally  tend  to  become  deflected  into  the  subsidiary 
sex  glands,  infections  of  these  structures  sometimes  occur 
without  involvement  of  the  testicles  or  epididymes.  Infec- 
tions of  the  subsidiary  glands  probably  as  a  rule  have  a 
greater  peril  for  genital  health  than  infections  of  the  epidid- 
ymis or  testicle,  because  when  the  latter  are  involved  the 
very  small  caliber  of  the  tubules  leads  to  early  atresia  with 
incarceration  of  the  infection,  while  the  structure  of  the 
subsidiary  glands  is  such  that  infected  secretions  may  read- 
ily escape  into  the  urethra  and  be  ejaculated  with  the  semen. 


Diseases  of  the  Seminal  Vesicles  787 

While  the  seminal  vesicles  of  stallions  have  not  been 
studied  from  a  pathologic  standpoint,  they  quite  certainly 
play  an  important  part  in  the  transmission  of  infection  to 
mares  during  coitus.  When  serious  abortion  storms  break 
in  a  harem  of  mares,  the  most  probable  source  of  infection, 
reasoning  from  analogy,  is  the  seminal  vesicles  of  the  stal- 
lion. Some  known  facts  support  this  suspicion.  Geldings 
frequently  show  purulent  semino-cystitis,  as  shown  in  Fig. 
228,  in  which  the  seminal  bladders  are  distended  with  pus 
until  their  size  exceeds  that  of  the  empty  urinary  bladder. 
I  doubt  if  castration  predisposes  to  such  infection  and  sus- 
pect that  a  careful  study  of  the  seminal  vesicles  of  stallions 
would  show  infections  of  the  vesicles  having  an  important 
relation  to  reproduction. 

Clinically  I  have  observed  one  stallion  and  have  known  of 
others  which  presented  symptoms  justifying  the  suspicion 
of  the  existence  of  serious  semino-vesiculitis.  The  stallion, 
an  imported  Percheron,  was  in  splendid  general  health  and 
quite  amorous.  The  erection  was  intense.  He  would  mount 
mares  promptly,  enter  the  penis  into  the  vagina,  hesitate, 
and  finally  dismount  without  ejaculation  and  with  the  penis 
greatly  erected.  From  more  recent  studies  upon  bulls  I  be- 
lieve that  the  symptoms  were  due  to  inflammation  of  the 
seminal  vesicles  of  a  severe  type  which  excluded  ejacula- 
tion. A  safe  diagnosis  is  available  in  such  cases  by  means 
of  rectal  palpation.  The  prognosis,  if  the  disease  is  clearly 
recognized,  is  probably  hopeless  as  to  reproduction  but 
favorable  for  the  life  of  the  animal.  No  line  of  treatment 
is  suggested. 


II.  THE  GENERAL  INFECTIONS  OF  THE 
GENITALIA  OF  MARES 

A.   Diseases  of  the  Ovaries 

1.    Atretic  Follicles 

The  ovaries  of  healthy  mares  owe  their  chief  volume  to 
the  presence  of  a  number  of  cysts,  reaching  a  diameter  of 
one  to  two  or  more  inches  and  containing  colorless  lymph. 
They  are  virtually  universal  in  young,  healthy  mares,  and 
at  three  to  four  years  of  age  constitute  more  than  seventy- 
five  per  cent,  of  the  ovarian  volume.  With  the  advent  of  old 
age  the  cysts  tend  to  disappear,  the  volume  of  the  ovary  de- 
creases greatly,  and  the  gland  becomes  distinctly  senile. 
The  cysts  have  not  been  studied.  Apparently  they  have  no 
pathologic  significance,  but  on  the  contrary  may  serve  an 
important  physiologic  ofiice. 

2.    Nymphomania 

Nymphomania  in  mares  bears  some  analogy  to  nympho- 
mania in  cows,  but  presents  some  very  marked  differences. 
It  has  already  been  stated  that  nymphomania,  as  observed 
in  the  cow,  is  due  to  a  type  of  cystic  degeneration  of  the 
ovary,  that  no  ovulation  occurs,  and  that  fertility  is  in  abey- 
ance. The  disease  designated  nymphomania  in  the  mare  is 
not  so  readily  recognizable  as  being  due  to  cystic  degenera- 
tion of  the  ovaries  and  its  existence  does  not  necessarily 
cause  sterility. 

Nymphomania  is  most  commonly  seen  in  mares  which  are 
kept  closely  confined  and  are  not  bred.  It  is  more  rarely 
observed  in  mares  regularly  worked  and  is  well-nigh  un- 
known in  those  which  are  free.  It  is  most  commonly  seen 
in  young  or  middle-aged  mares,  rarely  in  aged.  It  is  quite 
uncommon  in  mules,  though  in  one  instance  I  observed  the 
disease  in  so  marked  a  degree  as  to  render  the  otherwise 
valuable  animal  worthless  until  castrated. 


Nymphomania  789 

The  symptoms  of  nymphomania  in  the  mare  usually  ap- 
pear just  prior  to  estrum  or  during  that  period.  Estrum 
may  occur  with  comparative  regularity  but,  in  some  cases, 
is  apparently  more  frequent,  while  the  duration  of  the  pe- 
riod may  be  so  prolonged  that  the  intervals  of  calm  between 
the  periods  of  sexual  mania  may  be  very  brief. 

In  general,  the  first  symptom  of  nymphomania,  usually 
appearing  a  few  days  prior  to  estrum,  consists  of  excita- 
bility and  irritability  of  temper. 

The  patient  is  usually  more  or  less  vicious  toward  other 
horses  and  toward  men.  She  will  bite  and  kick  at  her  mate 
or  other  horses  when  approached.  Very  frequently  the  pa- 
tient will  crowd  against  the  pole  of  the  wagon  or  other  ve- 
hicle and  perhaps  lie  down  upon  it  in  an  effort  to  reach  her 
mate  and  inflict  injury.  She  manifests  her  viciousness  by 
laying  back  her  ears  and  switching  her  tail,  while  her  eyes 
and  physiognomy  in  general  betoken  evil  disposition.  The 
meeting  of  a  strange  animal  of  either  sex  upon  the  highway 
frequently  arouses  a  maniacal  storm;  the  mare  balks,  lies 
down  upon  the  pole  or  thills,  urinates  and  switches  her  tail ; 
the  vulva  is  rapidly  opened  and  closed;  the  clitoris  is 
erected;  and  the  affected  animal  may  attempt  to  grip  the 
reins  with  the  tail,  or  may  kick,  rear  or  run  away. 

Toward  persons  her  disposition  is  equally  disagreeable 
and  often  decidedly  dangerous.  Upon  entering  the  stall  to 
groom,  harness,  unharness  or  otherwise  handle  the  animal, 
she  is  liable  to  kick,  bite  or  trample  the  attendant  without 
warning.  In  hitching  or  unhitching  the  animal,  especially 
when  working  about  her  posterior  parts,  she  is  very  liable 
to  kick. 

In  the  stable,  even  when  no  other  animal  is  near,  the  pa- 
tient may  show  her  vice  by  kicking  the  sides  of  her  stall, 
striking  and  stamping  with  the  feet.  In  one  instance  in  our 
clinic,  the  mania  was  almost  exclusively  exhibited  when  the 
mare  was  alone  in  the  stall.  Watched  from  a  distance,  she 
would  stamp  her  feet  and  kick  the  sides  of  the  box  stall  in 
which  she  was  confined.  In  her  maniacal  kicking  she  was 
utterly  indifferent  to  the  consequences  to  herself  and  would 


7 go  Diseases  of  the  Genital  Organs 

frequently  and  repeatedly  kick  one  leg  viciously  with  the 
other.  Her  eyes  were  wild  and  staring  and  her  whole  ap- 
pearance and  behavior  one  of  violent  insanity.  If  her  owner 
or  other  person  entered  the  stall  she  became  calm,  began  eat- 
ing or  fondled  the  person  with  her  nose,  and  appeared  in 
every  way  rational  and  docile.  Turned  in  a  paddock  she  be- 
haved normally.  Hitched  in  the  usual  manner  to  a  single 
wagon,  she  behaved  perfectly.  The  duration  of  the  periods 
of  mania  and  its  intensity  had  increased  for  some  months 
until  the  degree  described  had  been  reached  and  the  attacks 
continued  during  seven  to  ten  days.  Ovariotomy  was  fol- 
lowed by  complete  and  permanent  disappearance  of  the 
mania. 

The  distinctively  sexual  symptoms  noted  consist  chiefly 
of  tumefaction  of  the  vulva,  injection  of  the  vulvar  mucosa, 
and  increased  secretion  of  mucus,  with  some  mucous  dis- 
charge from  the  vulva. 

Urination  is  frequent,  the  clitoris  is  erected  and  fre- 
quently protruded  between  the  vulvar  lips.  The  irritability 
of  the  vulva  and  vulvo-anal  region  is  markedly  increased 
and  the  animal  frequently  resents  violently  the  handling  of 
these  parts.  This  is  especially  true,  in  many  cases,  of  the 
tail;  the  animal  resents  the  raising  of  it  in  order  to  apply 
the  crupper  or  remove  it.  While  driving,  should  the  patient 
either  accidentally  or  intentionally  get  her  tail  over  the 
reins,  she  often  grips  them  violently,  kicks  viciously,  may 
turn  abruptly  and  upset  or  break  the  vehicle,  or  run  away. 

In  some  cases  the  patient  is  perfectly  docile  and  the  only 
signs  of  disease  consist  of  abnormally  frequent  urination 
with  repeated  opening  and  closing  of  the  vulva  and  the  pro- 
jection of  the  clitoris,  making  her  unfit  for  driving  purposes 
simply  from  repulsiveness. 

In  most  cases,  however,  the  patient  is  unreliable  or  dan- 
gerous and  can  not  be  depended  upon  in  moments  of  emer- 
gency. During  the  periods  of  nymphomania  she  is  very 
liable  to  be  unsteady  in  draft  work  and  may  at  any  moment 
balk  and  tax  the  patience  of  the  driver  very  greatly. 

Periodical  at  first,  the  vices  of  nymphomania,   such   as 


N\  'inpliomania  791 

kicking,  balking  and  gripping  of  the  reins  by  the  tail,  tend 
to  become  constant  and  permanent,  and  the  animal  degener- 
ates into  an  incurable  rogue,  falls  into  the  possession  of  low 
dealers  and  finally  finds  her  way  into  some  inhuman  hands, 
where  she  succumbs  to  brutal  work. 

Examined  macroscopically,  the  ovaries  are  usually  large 
and  contain  one  to  several  cysts,  varying  in  size  from  1/0-2 
in,  or  more  in  diameter  and  containing  a  clear,  faintly  yel- 
lowish lymph.  The  cyst  walls  are  thick  and  very  firm  and 
the  density  of  the  albuginea  preserves  to  a  large  extent  the 
even  contour  of  the  ovarial  surface,  so  that  it  is  only  in  case 


Fig.  229 — Cystic  Ovai-y,  Reduced      Nymphomania. 
A,  Normal  ovary  ;  />',  cystic  gland. 

of  quite  large  cysts  that  they  project  conspicuously  beyond 
the  general  surface  of  the  gland.  In  some  cases,  the  ovarian 
tissue  proper  vanishes  almost  completely  under  the  pressure 
of  large  cysts,  firmly  compressed  within  the  enveloping 
tunica  albuginea. 

In  other  extremely  bad  cases  of  nymphomania  there  are 
found  small,  atrophied,  fibrous  ovaries,  very  hard  and  dense, 
like  fibro-cartilage. 

The  examination  of  the  ovaries  of  the  mare  is  to  be  made 
upon  the  standing  animal,  in  essentially  the  same  manner 
as  that  described  for  the  cow.  Due  precautions  are  to  be 
taken,  according  to  circumstances,  to  avoid  injuries  to  the 
veterinarian  from  kicks  and  to  overcome  any  probable  an- 
noyance from  movements  of  the  animal.  Usually  a  single 
stall,  with  the  animal  tied  short  in  it,  will  suflSce,  but  vicious 


792  Diseases  of  the  Genital  Organs 

animals  should  be  secured  in  stocks,  the  twitch  applied,  and 
a  forefoot  held  up  or  one  hind  foot  raised  by  means  of  a 
sideline. 

The  hand  and  arm  of  the  operator  should  be  cleansed  and 
lubricated  with  warm  oil,  lard  or  liquid  paraffin.  The  rec- 
tum of  the  animal  should  be  emptied  of  feces.  Usually  little 
progress,  if  any,  can  be  made  while  the  hand  is  in  the  pos- 
terior or  pelvic  rectum.  It  becomes  necessary  to  push  gently 
forward  into  the  free  portion  of  the  bowel,  which  can  then 
be  carried  to  the  right  or  left,  up  or  down,  and  forward  or 
backward.  The  mare  often  strains  somewhat,  which  should 
always  be  a  signal  to  the  operator  to  cease  his  palpation  un- 
til the  expulsive  effort  ceases,  but  without  withdrawing  his 
hand.  Care  upon  this  point  decreases  the  straining  and 
does  much  to  avoid  laceration  of  the  rectal  mucosa,  asso- 
ciated with  hemorrhage. 

With  the  palm  of  the  hand  directed  downwards,  the  cer- 
vix and  uterus,  about  the  size  of  a  man's  wrist,  may  be 
traced  forward  to  the  point  of  bifurcation,  where  the  cor- 
nua,  almost  as  large  as  the  body,  are  given  off  at  approxi- 
mately right  angles.  Tracing  these  to  the  right  or  left,  the 
operator  can  recognize  the  ovaries  at  or  near  the  anterior 
margin  of  the  broad  ligament,  an  inch  or  two  beyond  the 
obtuse  end  of  the  cornua.  The  normal  gland  in  the  young 
or  adult  mare  is  elastic,  smooth,  firm,  oblong  and  about 
2V2-3'/2  inches  in  its  greatest  diameter,  by  li/>-2  inches  in 
its  lesser  diameter.  The  diagnosis  of  cystic  or  fibrous  de- 
generation of  the  ovaries  of  the  mare  and  the  relationship 
between  these  diseases  and  sterility  is  not  always  clear. 

How  many  nymphomaniac  mares  would  conceive  if  bred, 
is  not  known,  but  it  is  known  that  many  breed  and  that  the 
nymphomania  usually  disappears  during  the  span  of  preg- 
nancy, to  recur  with  some  degree  of  regularity  after  foal- 
ing. 

The  question  of  overcoming  sterility  due  to  cysts  or  other 
ovarian  disease,  with  a  view  to  the  restoration  of  the  breed- 
ing powers  in  valuable  brood  mares,  has  been  quite  neg- 
lected and  attention  turned  chiefly  toward  the  amelioration 


Infections  of  the  Gravid  Uterus  -jg;^ 

or  cure  of  the  vice  attending  the  malady,  in  order  to  restore 
the  work  value  of  the  animal.  Since  nymphomania  in  the 
mare  is  chiefly  observed  in  those  not  used  or  desired  for 
breeding,  this  tendency  in  handling  is  natural  and  sufficient. 
It  is  only  when  involving  animals  desired  for  breeding  pur- 
poses that  cure  of  the  disease  is  desired.  When  the  aim  to 
restore  fertility  is  frustrated  by  insurmountable  obstacles, 
the  duty  of  the  veterinarian  remains  to  preserve  to  the 
owner,  as  far  as  possible,  any  work  value  which  the  animal 
may  possess  when  relieved  of  the  nymphomania. 

Ovariotomy.  Oophorectomy.  When  nymphomania  re- 
ferable to  ovarian  disease  is  present  and  can  not  otherwise 
be  effectively  overcome,  castration  is  indicated. 

Since  in  mares  not  desired  for  breeding  purposes,  the  cure 
of  ovarial  nymphomania  otherwise  than  by  castration  is  all 
too  liable  to  prove  ephemeral  and  unreliable,  castration  at 
once  presents  itself  as  the  most  reliable  and  enduring  rem- 
edy. The  operation  is  comparatively  simple  and  not  highly 
dangerous.    It  has  been  fully  described  on  page  263. 

B.  Intra-Uterine  Infections  and  Infections  of  the  Embryo 

1.    Infections  of  the  Gravid  Uterus 

The  infections  of  the  gravid  uterus  are  not  generally  ob- 
served directly.  Their  presence  is  revealed  almost  solely  at 
the  termination  of  pregnancy,  at  which  time  the  ravages  of 
infection  become  apparent.  No  such  opportunity  is  offered 
for  the  study  of  the  pregnant  uteri  of  mares  as  is  afforded 
in  the  abattoir  upon  the  gravid  uteri  of  cows,  sows  and  ewes. 
When  pregnancy  terminates  in  parturition  or  abortion,  the 
lesions  due  to  infection  become  apparent,  enabling  the  clini- 
cian to  construct  a  picture  of  the  processes  as  they  have  oc- 
curred. Rarely  one  has  the  good  fortune  to  examine  oppor- 
tunely a  pregnant  mare  about  to  abort,  and  secure  direct 
data  upon  the  behavior  of  infection  within  the  uterus.  In 
so  far  as  studied,  the  behavior  of  the  infection  between  the 
chorion  and  uterine  mucosa  in  the  mare  is  perfectly  analo- 
gous to  the  better  known  processes  taking  place  in  the 


794  Diseases  of  the  Getiital  Organs 

gravid  uterus  of  the  cow.  There  is  one  fundamental  differ- 
ence in  the  placental  arrangement  which  changes  materially 
the  method  of  invasion.  The  utero-chorionic  space  of  the 
cow  facilitates  the  rapid  dissemination  of  infection  through- 
out the  entire  cavity  without  necessarily  involving  seriously 
the  placental  structures  (cotyledons).  In  the  mare  there  is 
no  utero-chorionic  space,  but  the  endometrium  everywhere 
participates  in  the  placental  functions,  so  that  the  endome- 
trium and  chorion  are  everywhere  in  intimate  placental 
contact.  Any  advancement  of  infection  along  a  given  path 
therefore  necessarily  destroys  the  placental  relation  between 
chorion  and  uterus.  The  chief  habitat  of  infections  within 
the  gravid  uterus  of  the  mare,  as  revealed  by  clinical  study, 
is  the  same  as  in  the  cow.  The  most  destructive  location  of 
infection  is  at  the  cervical  end  of  the  uterus,  from  which 
point  of  vantage  it  causes  abortion.  Clinical  experience 
clearly  teaches  that  the  second  bacterial  rendezvous  is  the 
apex  of  the  non-gravid  horn  where  it  may  develop  a  local- 
ized apical  endometritis,  revealed  at  the  termination  of  preg- 
nancy by  retention  of  the  chorion  in  the  non-gravid  horn, 
while  the  remainder  of  the  membranes  detach  promptly  and 
their  weight  causes  a  rupture  across  the  base  of  the  non- 
gravid  portion,  the  major  portion  of  the  membranes  falling 
away  while  the  diseased  non-gravid  branch  remains.  If 
one  has  the  opportunity  to  make  a  clinical  examination  of  a 
mare  nearing  abortion,  there  is  frequently,  p'erhaps  always, 
an  absence  or  destruction  of  the  uterine  seal,  the  cervical 
canal  is  open  and  suppurating,  and  the  chorion  is  detached 
from  the  uterus  over  a  varying  area  at  the  cervical  end. 
This  is  well  illustrated  in  Fig.  230.  The  parturient  rupture 
(1)  is  slightly  at  one  side  of  the  central  axis  because  there 
exists  a  central  hard,  somewhat  desiccated  necrotic  area  (2) 
which  possesses  greater  resistance  than  the  contiguous  area. 
The  photograph  reveals  at  3  the  radiation  of  the  infection 
from  2  toward  the  ovary.  In  some  cases,  if  not  in  many, 
the  veterinarian  making  an  examination  at  an  opportune 
time,  is  able  to  palpate  clearly  the  necrotic,  parchment-like 
area  of  the  chorion,  and  through  it  to  palpate  a  living  fetus 


Infections  of  the  Gravid  Uterus 


795 


and  cause  it  to  move.  So  far  as  I  have  been  able  to  observe, 
the  chorion  illustrated  in  Fig.  230  is  representative  of 
prompt  abortion.  Delayed  abortion  may  cause  such  disin- 
tegration of  the  chorion  as  to  destroy  the  plain  record  here 
shown  of  the  progress  of  infection. 

Abortion  in  mares  is  accordingly,  so  far  as  now  known, 
always  a  result  of  cervical  endometritis,  combined  with  a 
mortal  disease  of  the  embryo  or  fetus.  The  invasion  of  the 
fetus  is  identical  with  the  invasion  of  the  fetus  in  the  cow. 


Fig.  230— Fetal  Placenta  of  Abortion. 
/,  Parturient  rent  in  chorion  ;  2 ,    necrotic  area  opposite  the  os  uteri  inter- 
num ;  J,  inflamed  area  radiating  from  cervix  toward  ovarian  end  of 
uterus  ;  7,  gravid  horn  ;  5,  non-gravid  horn. 

The  infection  grows  through  the  chorion  at  the  necrotic  cer- 
vical area,  through  the  continuous  inflamed  area  (Fig.  230, 
3),  or  through  the  inflamed  tip  of  the  chorion  located  in  the 
non-gravid  horn.  When  the  allantoic  fluid  has  been  reached, 
the  invasion  may  continue  through  the  urachus,  but  usually 
penetrates  the  amnion  and,  suspended  in  the  amniotic  fluid, 
is  swallowed  by  the  fetus.  Then  sepsis  or  dysentery  may 
follow,  with  fetal  death.  Fetal  death  may  also  follow  ex- 
tensive placentitis  owing  to  asphyxia  or  to  placental  sepsis. 
The  endometritis  at  the  cervical  end  of  the  uterus  awakens 


jg'S  Diseases  of  the  Genital  Organs 

uterine  contractions  with  the  prompt  expulsion  of  the  fetal 
cadaver. 

Intra-uterine  infection  is  more  certain  to  cause  abortion 
in  the  mare  than  in  any  other  domestic  animal.  Since  the 
cervix  is  shorter  and  its  canal  more  dilatable,  less  power  is 
demanded  of  the  uterine  walls  to  force  the  fetal  cadaver 
into  the  cervical  canal,  at  which  point  the  abdominal  walls 
assume  the  chief  burden  of  emptying  the  uterus.  The  ana- 
tomical features  of  the  placenta  confine  the  infection,  at  least 
temporarily,  to  the  cervical  end,  as  indicated  in  Fig.  230, 
concentrate  the  uterine  irritation  more  definitely  at  the  cer- 
vical end,  and  leave  the  ovarian  end  free  from  disease  and 
competent  to  contract  vigorously  upon  the  uterine  contents. 
These  anatomical  differences  modify  interesetingly  the  clini- 
cal behavior  of  intra-uterine  infection.  While  it  is  not  rare 
for  a  bovine  fetal  cadaver  to  undergo  partial  or  complete 
maceration  in  the  uterus,  it  is  exceedingly  rare  to  observe 
this  result  in  the  mare.  The  mare  is  in  some  respects  more 
vulnerable  to  sepsis  than  the  cow,  but  if  this  plays  any  part 
at  all  it  is  a  minor  one.  Fetal  cadavers  (except  at  or  near 
full  term)  almost  never  undergo  putrid  decomposition  in 
the  uterus  of  the  mare,  but  are  practically  always  expelled 
promptly.  When  fetal  death  occurs  at  or  near  full  term,  the 
condition  is  essentially  alike  in  mare  or  cow.  It  is  common 
in  both  species,  especially  when  the  fetus  presents  by  the 
breech,  for  fetal  death  and  emphysema  to  occur  without 
visible  effort  at  expulsion.  The  phenomenon  of  abortion  in 
mares,  as  one  of  the  results  of  intra-uterine  infection,  has 
long  been  an  important  economic  problem  in  horse-breeding 
and  up  to  the  present  time  no  outstanding  progress  has  been 
made  in  its  control. 

Abortion  of  mares  first  acquired  prominence  in  the  United 
States  about  1886,  when  it  appeared  in  several  states  in  the 
Mississippi  Valley,  in  which  horse-breeding  had  become  a 
very  important  industry.  It  soon  acquired  a  very  extensive 
distribution  and  high  degree  of  virulence.  The  unorganized 
state  of  veterinary  science  in  the  United  States  prevented 
the  recording  of  any  definite  statistics  in  roferenci'  to  the 


Infections  of  the  Gravid  Uterus  797 

losses,  but  th«y  were  certainly  enormous.  At  that  time  I 
was  engaged  in  practice  in  what  was  then  one  of  the  most 
important  horse-breeding  districts  in  America.  In  1888,  in 
the  area  of  my  practice,  involving  about  400  square  miles, 
at  least  2500  mares  aborted,  causing  an  immediate  loss  of 
not  less  than  $150,000.  These  losses  were  typical  of  those 
in  other  breeding  centers.  In  some  townships  where  horse 
breeding  constituted  one  of  the  principal  agricultural  pur- 
suits, the  abortions  exceeded  seventy-five  per  cent,  of  the 
pregnant  mares.  The  losses  were  most  marked  in  large 
breeding  establishments  where  highly  valuable  mares  were 
kept  for  breeding  purposes  alone.  The  losses  were  just  as 
real  on  small  farms  where  but  a  few  mares  were  kept, 
which,  after  aborting,  could  be  employed  to  some  extent  in 
farm  work.  In  one  season  a  client  with  a  highly  valuable 
herd  of  about  fifty  imported  draft  mares  lost  every  foal 
from  abortion.  In  another  instance,  in  the  territory  of  a 
neighboring  veterinarian,  a  breeder  had  100  pregnant  im- 
ported draft  mares,  in  which  the  loss  from  abortion  was 
total  as  to  foals  and  four  of  the  mares  perished.  Other 
similar  instances  might  be  related  without  number  which 
would  give  a  somewhat  vivid  impression  of  the  enormous 
losses. 

As  in  cows,  so  in  mares,  intra-uterine  infection  may  and 
does  interrupt  the  reproductive  functions  at  any  date.  The 
spermatozoa,  the  ova,  the  fertilized  ova,  the  embryo,  the 
fetus  and  the  new-born  foal  may  succumb  to  the  infection, 
but  the  most  striking  phenomenon  is  the  observed  expulsion 
of  the  fetal  cadaver.  Consequently  abortion  is  said  to  be 
most  common  from  the  sixth  to  the  tenth  month,  because 
this  is  the  most  favorable  date  for  observing  the  disaster. 

The  symptoms  of  abortion  in  mares  are  less  notable  than 
in  cows.  Mares  rarely  suffer  from  retention  of  the  fetal 
membranes,  which  constitutes  a  common  landmark  of  abor- 
tion in  cows.  The  diagnosis  of  abortion  in  mares  is  there- 
fore usually  confined  to  observing  the  mare  in  the  act  or  dis- 
covering the  fetal  cadaver  under  circumstances  which  en- 
able one  to  trace  it  to  its  source. 


ygS  Diseases  of  the  Genital  Orgaiis 

The  lengthy  discussion  upon  the  question  of  abortion  in 
cows  will  serve  in  a  general  way  for  that  in  mares.  Al- 
though but  recently  the  belief  was  general  that  each  domes- 
tic animal  has  a  specific  infectious  abortion,  numerous  clini- 
cal and  biologic  studies  are  causing  a  disintegration  of  that 
theory.  Up  to  the  present  time  bacteriologists  have  gener- 
ally incriminated  but  one  organism  as  an  important  cause 
of  abortion  in  mares.  Smith  and  Kilborne,  Turner,  Lign- 
ieres,  De  Jong,  Good  and  Smith,  Meyer  and  Boerner,  and 
others  have  described  an  apparently  identical  organism, 
designated  by  Good  and  Smith^  Bacillus  ahortivo-equinus, 
which  they  severally  believe  is  the  cause,  or  an  important 
cause,  of  abortion  in  mares.  Running  through  the  recorded 
investigations  are  frequent  notes  of  discord.  Good  and 
Smith  failed  to  find  the  B.  abortiro-equinus  in  fetal  cadavers 
or  elsewhere  in  an  outbreak  among  Shetland  ponies,  and 
failed  to  report  what  other,  if  any,  bacteria  were  encoun- 
tered. In  another  case  the  highly  suggestive  admission  is 
made  that  the  breeding  stallion  had  orchitis  and  that  from 
the  testicle  was  obtained,  not  B.  abortiro-equinus,  but  B. 
pseudomonas  pyocyaneus,  and  that  colonies  of  the  same  ba- 
cillus were  obtained  from  other  sources  in  the  outbreak 
(fetal  cadavers,  fetal  membranes?).  The  general  attitude 
of  bacteriologists  regarding  the  infections  of  the  genitalia 
of  horses  has  been  analogous  to  that  in  the  investigations  in 
cattle :  if  the  organism  which  has  been  set  up  as  the  specific 
cause  of  abortion  is  present,  the  proof  is  complete  and  other 
bacteria  present  may  be  ignored;  if  it  is  not  present,  the 
abortion  is  not  "contagious",  though  an  abundance  of  bac- 
teria of  other  kinds  may  be  present. 

The  hypothesis  of  "contagious  abortion"  in  mares  as  a 
specific  disease  has  long  held,  and  continues  to  hold,  all  ef- 
forts at  control  in  abeyance.  There  can  be  no  reasonable 
doubt  at  this  time  that  a  broader  conception  of  the  problem, 
parallel  to  that  which  is  now  gaining  a  secure  foothold  re- 
garding the  genital  infections  of  cattle  and  which  has  won 
a  safe  place  in  the  battle  against  these  infections,  is  equally 

'  Ky.  Aj;.  I'.xp.  Sla.  Ihil.  204,  1916. 


Placentitis.     Endometritis  with  Retained  Fetal  Membranes     799 

applicable  to  the  genital  infections  of  horses.  If  a  horse 
breeder  desires  to  produce  a  vigorous  colt,  let  him  as  the 
first  step  breed  a  genitally  sound  mare  to  a  genitally  sound 
stallion. 

The  genitalia  of  the  mare  are  to  be  examined  the  same  as 
those  of  the  cow.  Any  cervicitis,  metritis  or  other  genital 
disease  discovered  is  to  be  handled  upon  the  same  funda- 
mental principles.  Stallions  used  to  serve  valuable  mares 
should  be  examined  at  intervals,  including  their  genital  or- 
gans, semen  and  spermatozoa.  During  pregnancy  mares 
should  be  guarded  (just  as  non-pregnant  mares  should  be) 
against  infectious  fevers,  such  as  *'pink  eye",  not  because 
they  can  apparently  cause  abortion  directly,  but  rather  be- 
cause, by  lowering  the  vitality  of  the  pregnant  mare,  the  re- 
sistance of  her  uterus  to  infections  residing  therein  is  low- 
ered and  disaster  invited.  The  maintenance  of  the  physical 
vigor  of  the  stallion  and  avoidance  of  sex  overstrain  should 
have  thoughtful  attention. 

2.    Infections  of  the  Puerperal  Uterus 

A.  Placentitis.      Endometritis  with  Retained  Fetal 
Membranes.     Puerperal  Laminitis. 

The  diffuse  placenta  of  the  mare,  spread  over  a  far 
greater  area  than  in  the  cow,  causes  the  placental  structures 
to  be  less  elaborate  and  renders  retention  of  the  fetal  mem- 
branes far  less  probable.  The  placentitis  which  may  cause 
retention  of  the  fetal  membranes  is  probably  as  common  in 
mares  as  in  cows,  but  the  chorionic  tufts  are  so  short  and 
simple  that  the  placentitis  runs  its  course  quickly  and  the 
dehiscence  of  the  placenta  usually  occurs  before  the  expul- 
sion of  the  fetus,  or  the  incarceration  is  so  feeble  that  the 
membranes  are  expelled  very  soon  after  the  fetus,  before 
retention  is  clinically  recognizable.  The  placental  arrange- 
ments are  such  that  endometritis  and  placentitis  become 
identical,  the  entire  endometrium  being  placental.  There 
exists  in  the  mare  also  a  remarkable  bond  between  the  pla- 
cental endometrium  and  the  sensitive  laminae  and  other 
horn-secreting  structures  of  the  foot,  so  that  when  placen- 


8oo  Diseases  of  the  Ccnital  Organs 

titis  of  a  severe  type  develops  there  occurs  promptly  as  a 
rule  a  severe  laminitis.  No  acceptable  explanation,  so  far 
as  I  know,  has  been  given  for  this  occurrence.  Some  say  it 
is  metastatic  inflammation,  but  they  do  not  explain  what 
they  mean  by  metastatic.  Puerperal  laminitis  is  common  in 
the  mare  and  very  rare  in  the  cow  and  ewe.  Two  types  of 
placentitis  with  retained  fetal  membranes  are  recognized 
clinically.  Generally  retention  of  the  fetal  membranes,  in 
which  the  placentitis  has  led  to  an  incarceration  of  the 
chorionic  tufts  over  most  of,  or  the  entire  uterine  mucosa, 
is,  according  to  my  observation,  very  rare.  It  is  rarely  seen 
in  abortion  because  the  placentitis  has  reached  that  point 
where  the  chorion  is  cast  off  before  the  fetus  is  expelled,  so 
that  cadaver  and  membranes  are  expelled  together,  the  same 
as  is  observed  usually  in  the  cow  when  abortion  occurs  in 
very  early  pregnancy.  I  have  seen  this  type  of  retention  in 
premature  birth,  but  the  premature  birth  itself  is  a  rare 
phenomenon  in  mares.  The  conditions  are  usually  analo- 
gous to  those  in  the  cow:  the  retention  begins  at  the  cervi- 
cal end  of  the  uterus,  as  illustrated  in  Fig.  230.  The  cervi- 
cal end  of  the  chorion  is  detached  or  detachable  soon  after 
the  fetus  is  expelled,  and  the  retention  increases  as  the 
ovarian  end  of  the  uterus  is  approached.  The  prognosis  is 
favorable  except  that  it  will  probably  be  complicated  by 
laminitis.  The  handling  is  along  the  general  lines  advised 
for  cows.  The  mechanism  of  manual  removal  differs  in  de- 
tail. The  margin  of  the  parturient  rent  at  the  cervical  end 
is  to  be  picked  up  and  tensed  with  one  hand  while  the  other 
hand  is  gently  pressed  between  the  chorion  and  uterine 
wall,  and  the  two  organs  carefully  pushed  apart,  or  a  part 
of  the  chorion  may  be  folded  longitudinally,  held  with  one 
hand  and  grasped  with  the  thumb  and  forefinger  of  the 
other  hand,  the  latter  pushed  forward  against  the  uterine 
wall,  and  the  two  organs  pressed  apart.  If  the  membranes 
are  not  removable  without  injury,  the  same  rule  applies  as 
in  cows.  Once  the  membranes  are  out,  the  uterus  should  be 
freely  douched  with  0.7',  salt  solution  as  frequently  as  may 
seem  expedient  and  the  iodoform-bismuth-oil  treatment,  ad- 
vised for  cows,  used. 


Placentitis.     Endometritis  with  Retained  Fetal  Membranes     80 1 

A  more  common  type  of  metritis  with  retained  fetal  mem- 
branes is  the  retention  in  the  non-gravid  horn.  As  a  rule 
the  fetus  lies  in  the  uterine  body  and  one  of  the  horns,  so 
that  the  non-gravid  horn  does  not  develop  markedly.  As  in 
the  cow,  the  non-gravid  horn  habitually  suffers  more  se- 
verely from  infection  present  than  the  gravid  horn.  Pre- 
sumably this  is  due  to  the  lower  vitality  of  the  non-gravid 
horn  of  the  chorion,  making  it  more  vulnerable  to  bacterial 
attack.  It  may  well  be,  however,  that  the  cornual  apex  and 
the  oviduct  are  fundamentally  worse  affected  in  many  cases, 
so  that  pregnancy  is  barred  upon  that  side  but  remains  pos- 
sible upon  the  less  infected  side.  Whatever  may  be  the  cor- 
rect explanation,  the  fact  remains  that  the  non-gravid  cornu 
frequently  suffers  severely  from  a  localized  endometritis, 
the  crypts  are  deep  and  irregular,  and  the  chorionic  tufts 
gross  and  uneven,  showing  great  variability  in  color.  At 
one  point  the  chorion  is  intensely  red  and  angry ;  at  another, 
a  necrotic-like,  dirty  gray.  The  other  portions  of  the  endo- 
metrium may  be  healthy.  When  parturition  occurs,  there  is 
prompt  dehiscence  of  the  healthy  chorion  in  the  gravid  horn 
and  uterine  body,  but  the  chorion  in  the  non-gravid  horn  is 
incarcerated.  It  is  usually  narrowed  at  its  juncture  with 
the  uterine  body  and  fragile  from  disease.  The  weight  of 
the  detached  chorion  of  the  gravid  horn  and  the  body  drags 
upon  the  frail  prolongation,  it  parts,  the  chief  mass  drops 
away,  and  the  non-gravid  prolongation  remains  incarcerated 
and  out  of  sight.  Conditions  are  then  ripe  for  an  explosion. 
The  entire  endometrium  of  the  gravid  horn  and  uterine 
body,  approximately  fifteen  to  twenty  square  feet  in  area, 
is  wholly  denuded  of  protective  epithelium  and  highly  vul- 
nerable to  invasion.  There  rests  in  the  badly  diseased  non- 
gravid  horn  a  large  volume  of  infection  in  the  presence  of 
a  large  mass  of  necrotic  chorion  already  saturated  with  in- 
fection. The  accumulated  infection  pours  out  into  the  uter- 
ine cavity  and  gravid  horn,  and  the  necrotic,  putrefying 
fragment  of  chorion  drops  into  the  uterine  cavity.  The 
spread  of  the  infection  is  rapid.  Marked  clinical  symptoms 
quickly  appear.    Within  twenty-four  to   forty-eight  hours 


8o2  Diseases  of  the  denital  Organs 

the  mare  is  evidently  in  great  distress,  she  lies  down  most 
of  the  time,  her  appetite  is  poor  or  absent,  and  her  pulse 
weak,  though  her  temperature  not  markedly  elevated,  prob- 
ably because  of  relaxation  of  the  anal  sphincter  which  ad- 
mits air  about  the  thermometer.  There  may  be  an  involun- 
tary escape  of  a  thin,  flaky,  dirty  grayish  pus,  flecked  with 
blood  from  the  vulva.  Manual  exploration  of  the  uterus  re- 
veals a  paretic  organ  containing  three  or  four  quarts  to  as 
many  gallons  of  thin,  dirty  gray  pus,  sometimes  almost 
odorless,  and  sometimes  fetid.  Somewhere  floating  in  the 
mass  or  still  lying  in  the  non-gravid  cornu  may  be  found  the 
necrotic,  putrefying  fragment  of  chorion.  If  compelled  to 
stand,  the  mare  exhibits  the  clinical  picture  of  laminitis 
(puerperal  laminitis)  with  tenderness  of  the  abdomen  upon 
pressure.  The  localized  endometritis  has  suddenly  devel- 
oped into  an  intense  generalized  endometritis  with  severe 
laminitis. 

The  veterinarian  in  charge  of  valuable  brood  mares  should 
either  have  the  fetal  membranes  of  each  mare  laid  aside  for 
his  prompt  inspection,  or  should  teach  the  caretaker  how  to 
inspect  the  membranes  and  determine  if  all  has  come  away. 
If  the  non-gravid  prolongation  is  wanting,  it  should  be  re- 
moved manually  very  promptly,  the  uterus  douched  with 
salt  solution,  and  iodoform-bismilth-oil  introduced.  This 
will  generally  prevent  the  development  of  severe  endometri- 
tis and  laminitis. 

If  such  precautions  are  not  taken  and  the  intense  disease 
has  developed,  the  necrotic  fragment  is  to  be  removed  if 
found,  the  pus  douched  and  siphoned  from  the  uterus,  and 
the  iodoform-bismuth-oil  introduced  ( '  •_>  to  1  oz.  each  of  bis- 
muth and  iodoform  in  one  quart  of  olive  or  salad  oil  or  of 
liquid  paraflin).  The  treatment  should  be  repeated  often 
enough  to  prevent  large  accumulations  in  the  uterus.  The 
laminitis  must  have  earnest  attention.  If  the  animal  can 
stand  without  great  pain  or  fatigue,  she  may  be  placed  in  a 
flowing  stream  of  cool  water  or  stood  in  an  improvised  foot 
bath  kept  cold  with  ice.  If  she  can  not  stand  without  great 
suffering,  packs  of  broken  ice  should  be  kept  ujion  her  feet. 


Metritis.      Metro- Peritonitis  803 

There  is  scant  need  for  internal  medication  except  for  the 
uterine  douchings  already  described.  The  disease  is  based 
upon  intra-uterine  infection.  When  that  is  controlled,  the 
animal  usually  improves  rapidly  and  recovers  completely. 
Should  symptoms  arise  demanding  medication,  the  details 
should  be  adapted  to  the  individual  case.  If  the  sepsis  ap- 
pears profound,  it  can  probably  best  be  overcome  by  large 
doses  (1  oz.  or  more)  of  potassium  iodide  or  quinine.  Con- 
stipation or  intestinal  atony  can  be  most  safely  overcome 
with  minute  doses  of  eserin  or  arecolin  combined  with 
strychnine. 

B.  Metritis.     Metro-Peritonitis. 

The  placentitis  or  endometritis  of  the  preceding  article  is 
necessarily  an  intrinsic  infection  which,  so  far  as  known, 
has  existed  within  the  uterus  at  least  throughout  pregnancy. 
There  occur  some  cases  of  metritis  differing  in  type  from 
that  described  above  and  referable  to  either  intrinsic  or  ex- 
trinsic infection.  In  veterinary  practice  the  practitioner  is 
not  ordinarily  responsible  for  introducing  infection,  through 
imperfect  technic,  into  the  genital  tract  at  the  time  of  par- 
turition. The  veterinarian  rarely  invades  a  uterus  not  al- 
ready importantly  infected.  He  interferes  in  dystocia  only, 
and  dystocia  in  animals  is  due  chiefly  to  infection  within 
the  uterus,  causing  atony  of  its  walls,  or  to  death  or  serious 
illness  of  the  fetus  from  the  same  infection  which  destroys 
its  power  to  assume  and  maintain  the  correct  direction  and 
position  of  its  extremities.  In  such  cases  the  veterinarian 
does  not  introduce  the  primary  infection,  but  may  add  other 
forms  of  bacteria  more  perilous  than  those  already  present. 

When  intra-uterine  infection  causes  the  death  of  an  al- 
most or  wholly  mature  fetus,  especially  if  the  fetus  presents 
by  the  breech,  there  may  occur  no  visible  effort  at  expulsion, 
but  instead  the  fetus  undergoes  rapid  emphysema.  The  al- 
ready badly  inflamed  uterus  rapidly  becomes  worse  owing 
to  the  presence  of  the  decomposing  fetal  membranes  and 
fetus.  Under  such  conditions  the  walls  of  the  uterus  gen- 
erally become  paretic,  greatly  thickened  and  hard.     Por- 


8o4  Diseases  of  the  Geyiital  Organs 

tions  of  the  decomposing  chorion  or  amnion  may  protrude 
from  the  vulva,  but  there  are  no  expulsive  efforts.  The 
uterus  is  powerless  to  act  upon  its  contents.  The  great  thick- 
ening of  the  uterine  wall  is  largely  confined  to  the  placental 
tissues.  If  the  emphysematous  fetal  cadaver  is  removed 
by  embryotomy  or  otherwise  and  the  uterus  douched  clean, 
the  mare  probably  recovers  and  may  retain  her  fertility. 
The  removal  of  the  emphysematous  cadaver  is  described  in 
the  companion  volume,  Yeteriyiary  Obstetrics. 

Although  puerperal  metritis  in  animals  is  almost  always 
the  continuation  of  the  metritis  of  pregnancy  into  the  puer- 
peral period,  the  puerperal  metritis  is  aggravated  by  the 
dehiscence  of  the  chorion  and  exposure  thereby  of  the  entire 
denuded  area  to  the  infection  present.  Parturient  con- 
tusions and  lacerations  are  frequent  and  are  at  times  peril- 
ous. The  layman  undertaking  obstetric  work  and,  still  more 
dangerously,  the  careless  and  dirty  veterinarian  coming 
from  other  highly  infected  cases,  frequently  introduces  dan- 
gerous types  of  infection  into  the  uterus  with  dirty  hands, 
instruments  or  apparatus. 

One  of  the  most  serious  parturient  contusions  is  that  due 
to  impingement  of  the  floor  of  the  uterus  or  cervix  between 
a  firm,  bony  part  of  the  fetus  and  the  conical  protuberance 
projecting  into  the  pelvic  cavity  from  the  anterior  end  of 
the  symphysis  pubis.  This  sometimes  perforates  the  floor 
of  the  genital  tract  directly,  but  more  frequently  so  maims 
the  tissues  that  necrosis  occurs  and  infection  penetrates  the 
peritoneal  cavity.  Then  a  violent  metro-peritonitis  ensues, 
which  commonly  results  in  death.  Sometimes  virulent  in- 
fection invades  the  floor  of  the  genital  canal  through  the 
lacerated  tissues  and,  spreading  out  from  the  point  of  in- 
vasion, sets  up  a  malignant  and  fatal  phlegmon  involving 
the  utero-cervico-vaginal  floor,  the  urinary  bladder  and 
neighboring  parts.  The  patient  then  exhibits  all  the  signs  of 
profound  sepsis  with  great  depression,  erratic  temperature 
and  disinclination  to  move  because  of  the  great  pain  in  the 
pelvis.  Vaginal  or  rectal  palpation  reveals  extensive  phleg- 
mon or.  in  mild  cases,  abscesses  in  the  i^elvic  tissues,  largely 


Post- Puerperal  Infections  of  the  Uterus  805 

lying  below  the  floor  of  the  genital  tract.  Little  of  value  is 
known  which  may  be  applied  to  control  or  ameliorate  the 
ravages  of  the  infection.  The  phlegmon  is  so  erodent  that 
the  exudate  generally  makes  its  way  into  the  peritoneal 
cavity.  If  abscesses  point  toward  the  vagina  or  rectum, 
they  may  be  opened  into  either  of  these,  but  in  my  experi- 
ence they  fail  to  do  this,  and  I  have  failed  to  identify  a  spot 
where  it  appeared  prudent  to  penetrate  the  virulent  area. 
Heavy  doses  of  potassium  iodide,  quinine  or  both  may  be 
tried,  but  without  material  hope.  Prevention  is  dependent 
upon  careful  obstetric  practice  which  it  is  not  proper  to  dis- 
cuss here. 

3.    Post-Puerperal  Infections  of  the  Uterus 

The  infections  of  the  pregnant  uterus  may  continue  into 
the  puerperal  period,  receive  additional  invasions  at  that 
time,  and,  with  these,  persist  indefinitely.  They  are  un- 
limited in  variety,  including  essentially  any  bacteria  com- 
petent to  induce  wound  infection.  They  may  continue  into 
the  next  breeding  season  and  prevent  conception,  or,  failing 
to  do  this,  may  imperil  the  life  of  the  embryo  of  fetus,  or 
finally  a  portion  of  the  infection  may  persist  in  the  fetus  at 
birth,  constituting  a  hazard  to  the  new-born  foal,  and  a  part 
continue  in  the  uterus  of  the  mare.  The  most  prominent 
types  are  the  following : 

a.  Chronic  endometritis  ivith  mucous  or  muco-purulent 
exudates.  In  such  instances  the  uterus  is  enlarged,  flaccid 
and  atonic.  Estrum  may  be  regular,  but  conception  largely 
fails  or,  if  it  occurs,  the  embryo  or  fetus  will  probably  per- 
ish. If  the  uterus  is  examined,  the  cervix  is  generally  found 
soft  and  its  canal  open.  If  the  uterus  is  douched,  some 
muco-pus  is  probably  washed  out. 

Spontaneous  recovery  is  uncertain,  but  as  a  rule  the  con- 
dition will  respond  to  proper  handling.  The  principles  of 
handling  are  the  same  as  for  the  analogous  disease  of  the 
cow.  The  commodious  vulva  and  vagina  and  the  freely  dila- 
table cervix  render  handling  simpler  and  easier  than  in  the 
cow.     In  douching  the  uterus  of  the  mare  the  practitioner 


o  6  Diseases  of  the  Genital  Organs 

should  bear  in  mind  the  fact  that  the  very  large  cornua 
leave  the  uterine  body  at  right  angles,  or  somewhat  re- 
curved. The  ordinary  metal  catheter  used  for  the  cow  is 
not,  therefore,  a  wholly  suitable  instrument  for  the  mare 
because  it  can  not  readily  follow  the  right  angle  turn  from 
the  cavity  of  the  uterine  body  into  the  horn.  The  soft  rub- 
ber horse  catheter,  guided  into  the  base  of  the  uterine  horn 
with  a  sound  shaped  somewhat  like  the  modified  Palmer 
uterine  dilators  (Fig.  39,  2)  may  be  safely  pushed  to  the 
cornual  apex.  The  cornu  may  then  be  cleansed  by  siphoning 
or,  owing  to  the  ample  cervical  canal,  may  be  flushed  out, 
the  return  flow  escaping  alongside  the  catheter. 

b.  Uterine  abscess  not  rarely  follows  severe  puerperal 
metritis.  A  severe  inflammation  of  the  cervical  mucosa  oc- 
curs at  a  period  when  there  is  little  escape  of  exudate  from 
the  uterine  cavity,  permitting  the  contiguous  cervical  sur- 
faces to  adhere  and  block  the  cervical  canal.  The  imprisoned 
pyogenic  infection  multiplies  rapidly  and  soon  distends  the 
uterus.  The  distended  organ  becomes  powerless  and  the  dis- 
tension grows.  Eventually  colicky  symptoms  develop,  and 
in  some  cases  there  are  painful  and  violent  expulsive  efforts. 
Soon  two  to  five  or  more  gallons  of  pus  accumulate  and  the 
patient  is  in  severe  distress.  If  left  to  itself,  in  the  cases  I 
have  observed,  the  abscess  usually  points  through  the  cervi- 
cal canal  and  ruptures  into  the  vagina.  In  the  process  the 
cervix  as  a  definite  structure  disappears  and  most  of  its 
substance  constitutes  a  part  of  the  posterior  wall  of  the  ab- 
scess. The  OS  uteri  externum  is  firmly  closed  and  marks  ap- 
proximately the  center  of  the  abscess  from  behind. 

The  symptoms  are  those  of  general  ill  health  until  the  ten- 
sion within  the  abscess  becomes  great,  when  abdominal  pain 
and  expulsive  eff'orts  constitute  the  two  pronounced  indica- 
tions. In  conjunction  with  a  history  of  recent  parturition, 
especially  of  dystocia  or  retained  fetal  membranes,  uterine 
abscess  should  be  suspected.  Manual  exploration  through 
the  vagina  causes  pain  and  expulsive  efforts.  The  vagina 
may  be  normal,  but  is  probably  shortened  owing  to  the  ab- 
scess pushing  backwai-d.   Palpation  reveals  the  tense,  fluctu- 


Post- Puerperal  Infcclioiis  of  tlic  Uterus  807 

ating  abscess,  the  posterior  wall  of  which  occupies  most  of, 
or  the  entire  lumen  of  the  pelvic  cavity.  Careful  search 
usually  reveals  traces  of  the  os  uteri  externum,  the  lips  of 
which  form  a  ring  about  the  occluded  mouth.  The  cervical 
canal  is  nowhere  to  be  found.  Rectal  exploration  reveals 
the  presence  of  a  great,  tense  abscess,  continuous  with  the 
anterior  end  of  the  vagina. 

The  prognosis  is  good  for  the  life  of  the  mare,  but  essen- 
tially hopeless  for  her  fertility.  The  treatment  consists  of  a 
free  opening  of  the  abscess  with  disinfection  of  its  cavity. 
Careful  palpation  by  both  vagina  and  rectum  should  be  made 
and  the  position  of  the  os  uteri  externum  located  approxi- 
mately. In  case  of  doubt  a  small  trocar  may  be  used  to  ex- 
plore and  the  abscess  cavity  adequately  located.  The  trocar 
puncture  may  then  be  dilated  by  incising,  and  later  the  en- 
largement may  be  continued  by  forcing  the  hand  through 
the  wound  into  the  abscess  cavity.  It  should  then  be  handled 
like  any  abscess  cavity,  except  that  it  is  to  be  remembered 
that  antiseptics  in  escaping  must  flow  over  the  vaginal  walls 
and,  if  too  irritant,  may  cause  serious  harm.  The  opening 
must  be  kept  amply  dilated  until  suppuration  has  ceased. 
As  a  rule  the  uterine  cavity  will  probably  become  obliter- 
ated. 

c.  Pijometra.  The  short,  broad  and  readily  dilatable  cer- 
vix of  the  mare  renders  her  less  subject  than  the  cow  to  pyo- 
metra.  So  far  as  I  have  observed,  pyometra  may  well  be 
considered  as  a  secondary  lesion  to  cervicitis.  The  cervix 
becomes  inflamed  and  greatly  indurated,  incarcerating  in- 
fection within  the  uterine  cavity.  The  uterine  walls  parti- 
cipate importantly  in  the  process,  and  ultimately  become 
quite  paretic,  and  the  indurated  cervix,  encroaching  upon 
the  canal,  so  narrows  it  that  the  pus  contents  of  the  uterus 
are  not  actively  expelled.  The  principles  involved  are  illus- 
trated in  Fig.  231. 

The  symptoms  are  chiefly  an  intermittent,  sometimes  a 
constant,  vulvar  discharge.  Uusually  the  discharge  is  fetid 
and  consists  of  rather  thick,  dirty,  yellowish  pus.  In  one  of 
my  cases  the  pus  was  black  and  looked  like  finely  pulped 


8oS 


Diseases  of  the  (ie)iital  Organs 


melanotic  tissue  suspended  in  fluid.  Pyometra  passes  im- 
perceptibly into  uterine  abscess.  In  some  cases  of  pyometra 
the  discharge  ceases  for  ten  to  thirty  or  more  days,  colic 
may  appear,  and  finally  the  indurated  cervix  yields  to  the 
intra-uterine  pressure  and  the  pus  escapes  in  large  quanti- 
ties. In  many  cases  the  discharge  occurs  only  when  the  ani- 
mal is  recumbent,  since  the  escape  of  the  pus  is  passive,  due 
to  the  increased  intra-abdominal  pressure  caused  by  the 
position  of  the  patient.  In  some  cases  the  incarceration  of 
the  pus  is  the  result  of  contraction  of  the  cervix.  I  have 
seen  great  quantities  of  pus  escape  from  the  uterus  while 
the  patient  was  under  complete  chloroform  anesthesia  for 


Fig.   231— Pyometra. 

/'.Vagina;    (f ',  greatly  thickened,   sclerotic   cervix 
UC,  cornu  ;  O,  ovarw 


I ',    uterus 


other  reasons.  The  disease  shows  no  tendency  to  sponta- 
neous recovery.  The  physical  health  of  the  animal  can  al- 
most always  be  restored.  I  have  not  known  a  mare  to  con- 
ceive later.  The  oviducts  are  probably  blocked.  The  veteri- 
narian should  on  no  account  leave  the  application  of  the 
treatment  in  the  hands  of  a  layman.  If  the  practitioner  can 
not  have  the  patient  under  his  immediate  control,  he  had 
best,  for  his  professional  reputation,  let  it  alone.  The 
handling  must  be  vigorous  and  continuous  in  order  to  assure 
satisfactory  results. 

The  treatment  consists  of  the  surgical  dilation  of  the  cer- 
vical canal,  wth  disinfection  of  the  uterine  cavitv.  The  tech- 


Post- Puerperal  Infections  of  the  Uterus  809 

nic  of  cervical  dilation  may  be  varied  according  to  condi- 
tions. Frequently  the  operator  may  dilate  the  canal  manu- 
ally. First  one  finger  is  pushed  through  the  canal,  then  a 
second  finger,  and  finally  the  entire  hand.  It  is  not  usually 
desirable  to  attempt  the  complete  dilation  at  one  operation, 
but  the  effort  should  be  renewed  daily  until  success  is  at- 
tained. If  room  permits,  after  the  pus  has  been  washed  out 
of  the  uterus,  the  closed  end  of  a  long  cheesecloth  bag  may 
be  introduced  into  the  uterus  and  the  bag  then  filled  by  pack- 
ing a  continuous  long  strip  of  cheesecloth  into  it  by  means 
of  long  dressing  forceps,  uterine  dilators,  or  other  instru- 
ment. A  rubber  dilator  patterned  after  those  used  in  human 
practice  can  be  used  in  some  instances.  The  veterinarian 
needs  to  select  his  method  according  to  circumstances,  and 
persist  day  after  day  until  ample  dilation  has  been  attained. 
I  have  set  my  mark  at  sufficient  dilation  to  permit  the  pas- 
sage of  my  hand. 

Once  ample  dilation  has  been  accomplished,  effort  may  be 
centered  upon  disinfection  of  the  suppurating  cavity.  The 
disinfection  should  be  largely  mechanical,  douching  out  the 
pus  with  physiologic  salt  solution,  boric  acid  or  other  very 
mild  disinfectants.  The  soft  rubber  horse  catheter  may  be 
used  advantageously  for  douching  and  siphoning.  After 
cleansing  the  uterus  as  thoroughly  as  practicable  by  these 
means,  improvement  may  follow  the  introduction  of  iodo- 
form or  bismuth  subnitrate,  or  both,  in  liquid  paraffin.  At 
first  the  uterus  should  be  handled  daily  because  the  force 
used  in  dilating  the  cervix  accelerates  the  infection  and  gen- 
erally causes  fetor  or  increases  the  fetor  existing.  Later, 
as  the  uterus  and  cervix  soften  and  approach  their  normal 
size,  consistency  and  function,  the  handling  should  be  con- 
tinuously toned  down  and  finally  discontinued,  but  the  pa- 
tient should  still  be  examined  from  time  to  time  for  a  few 
weeks  to  make  sure  that  no  perilous  trace  of  infection  has 
been  left  behind. 

d.  Puemic  abscesses  from  metritis  are  rare  in  mares.  I 
have  observed  them  occasionally  in  the  pelvic  tissues  and, 
in  one  instance  following  dystocia,  in  the  sub-lumbar  lymph 
glands.   There  appears  to  be  scant  inclination  to  the  pyemic 


8io  Diseases  of  the  Genital  Organs 

arthritis  so  often  seen  in  cows.  When  pyemic  abscesses  oc- 
cur in  or  about  the  pelvis,  or  in  the  sublumbar  lymph  glands, 
they  are  recognizable  by  means  of  rectal  and  vaginal 
palpation. 

The  abscesses  may  be  opened  into  the  rectum  or  the  va- 
gina, if  adherent  to  these  organs.  If  not  adherent  to  these, 
but  closely  adherent  to  the  abdominal  walls,  they  should  be 
opened  by  external  incision.  This  is  safely  done  with  the 
mare  under  complete  anesthesia.  The  operator  inserts  one 
hand  into  the  rectum  as  a  guide  and  penetrates  the  abdomi- 
nal and  abscess  walls  with  a  scalpel  operated  by  the  other 
hand.  Most  of  the  incision  may  be  made  by  an  assistant 
but,  when  the  peritoneum  is  reached  or  closely  approached, 
the  operator  with  his  one  hand  in  the  rectum,  resting  upon 
the  abscess,  can  guide  the  scalpel  with  his  other  hand  with 
greater  safety  and  accuracy  than  can  others.  The  opening 
should  be  free  and  the  general  rules  for  handling  abscesses 
applied. 

4.    Cervicitis 

It  has  already  been  stated  that  pyometra  in  the  mare  is 
largely  caused  by,  or  at  least  intimately  associated  with  cer- 
vicitis. On  the  whole,  cervicitis  is  rare  in  the  mare  as  com- 
pared to  ruminants.  This  is  largely  owing  to  the  far  sim- 
pler anatomical  plan  of  the  cervix.  It  is  shorter,  its  canal 
broader  and  its  mucosa  much  simpler.  There  are  fewer  of 
the  highly  complex  longitudinal  and  annular  mucous  folds 
in  which  bacteria  may  attain  a  secure  habitat.  The  most 
marked  exceptions  to  this  rule  is  met  in  pyometra,  where, 
as  shown  in  Fig.  231,  the  cervical  walls  are  invaded  and  be- 
come greatly  thickened  and  indurated. 

In  a  milder  way  (catarrhal  endocervicitis)  the  cervix  par- 
ticipates in  the  infections  of  endometritis  and  api)arently 
contributes  importantly  to  the  production  of  sterility.  It 
has  generally,  however,  an  effect  approximately  opposite  to 
that  observed  in  the  cervicitis  of  cows.  Instead  of  causing 
constriction  of  the  cervix,  it  usually  causes  paresis  of  the 
walls  and  dilation  of  the  cervical  canal.  That  is,  the  cervix 
of  the  mare  under  the  invasion  of  ordinary  infections  pur- 
sues a  course  essentially  parallel  to  the  lesions  in  tlic  uterus 


Vaginitis 


8ii 


suffering  from  endometritis.  Both  uterus  and  cervix  be- 
come flaccid  and  atonic.  In  the  cow  the  uterus  becomes 
flaccid  while  the  cervix  indurates. 

The  prognosis  is  good  and  the  handhng  is  to  be  based 
upon  the  general  principles  detailed  for  the  cow.  The  uterus 
is  to  be  so  handled  that  it  will  not  be  discharging  muco-pus 
over  the  cervical  mucosa,  and  the  cervix  itself  is  to  be  dis- 
infected the  same  as  in  the  cow%  especially  by  swabbing  the 
cervical  mucosa  with  Lugol's  solution,  silver  nitrate,  zinc  or 
copper  sulphate. 

5.  Vaginitis 

The  specific  vaginitis  of  genital  horse  pox  has  already 
been  described.  The  organ  is  sensitive  to  irritants.  Vagini- 
tis may  be  aroused  in  endless  ways.  However,  mares  ap- 
parently escape  the  virtually  omnipresent  lesions  of  the  nod- 
ular venereal  disease  of  ruminants  and  swine  which  serve  in 
them  as  a  foundation  for  vaginitis  which  may  be  aroused  by 
slight  insult. 

Parturient  contusions  and  abrasions  are  the  commonest 
causes  of  severe  vaginitis.  Doubtless  imprudent  vaginal 
douching  sometimes  causes  vaginitis  in  mares  as  well  as  in 
cows.  In  one  instance  a  mare  was  brought  to  me  suffering 
intensely  with  prolapse  of  the  vaginal  floor  and  the  urinary 
bladder  (vesico-vaginocele)  following  coitus.  She  had  se- 
vere vaginal  atresia  from  prior  disease.  Since  she  had 
changed  ownership  (probably  because  of  the  unseen  dis- 
ease) the  history  leading  up  to  the  atresia  was  not  available. 
It  was  not  improbably  due  to  imprudent  vaginal  douching. 
I  was  compelled  to  produce  profound  choral  narcosis  for 
several  hours  in  order  to  control  the  prolapse. 

Vaginitis  varies  greatly  in  severity  and  duration.  When 
not  too  severe,  it  usually  tends  to  recover  spontaneously; 
when  severe,  it  may  tend  to  persist  permanently  and  cause 
either  vaginal  atresia,  as  in  the  instance  related,  or  severe, 
intractable  pyo-vaginitis  which  may  ruin  the  value  of  the 
patient.  The  infection  may  extend  forward  to  involve  the 
cervix  and  uterus,  or  pus  flowing  backward  over  the  urethra 
may  traverse  that  canal  and  set  up  a  very  serious  pyo-cysti- 
tis. 


8i2  Diseases  of  the  Genital  Organs 

The  veterinary  obstetrist  should  always  anticipate  vagi- 
nitis in  cases  of  dystocia,  retained  fetal  membranes,  metri- 
tis, and  other  diseases  of,  or  injuries  to  these  parts.  If  se- 
vere parturient  vaginal  abrasions  are  present,  every  possi- 
ble detail  of  cleanliness  and  asepsis  should  be  applied  as  pre- 
ventive measures,  such  as  frequent  douches  with  physiologic 
salt  solution,  a  very  weak  Dakin's  solution,  or  some  one  of 
the  approximate  substitutes  for  it.  One  may  apply  in  con- 
junction with  these,  or  alone,  one  of  the  bland  oils  holding  in 
suspension  iodoform  or  other  non-irritant  antiseptic.  Medi- 
cated suppositories  of  beeswax  or  soft  parafhn  may  also  be 
used  with  advantage. 

6.    Cystitis 

Cystitis  occurs  in  mares  as  an  extension  of  vaginitis  or 
vulvitis  along  the  short  and  broad  urethra.  1  was  called  to 
attend  a  mare  for  dystocia  after  laymen  had  exhausted  their 
powers.  The  fetus  presented  anteriorly,  dorso-sacral  posi- 
tion, with  both  hind  feet  extended  beneath  its  body  into  the 
pelvis.  The  laymen  had  bisected  the  fetus  through  the  chest 
without  preserving  a  flap  and  the  torso  receded  far  enough 
that  the  exposed  vertebra  and  ribs  lacerated  and  contused 
the  vaginal  mucosa  severely.  I  removed  the  torso  after  a 
second  bisection.  Some  weeks  later  I  was  called  again  to  see 
the  mare  and  found  her  suffering  from  severe  vaginitis,  vul- 
vitis and  cystitis.  The  cystitis  was  the  most  formidable  of 
the  lesions.  The  meatus  was  open  and  the  index  fmger  could 
readily  be  passed  into  the  cavity  of  the  bladder.  The  walls 
of  the  bladder  were  thickened  and  the  mucosa  was  thrown 
into  extensive  folds  which  were  covered  by  crusts  of  urinary 
salts,  mixed  with  pus.  The  purulent  urine  had  a  very  fetid 
odor.  The  cavity  of  the  bladder  was  small  and  the  thickened 
walls  paretic  and  inextensible,  so  that  the  urine  flowed  from 
the  bladder  involuntarily,  producing  an  intense  irritation  of 
the  vulva.  Dribbling  down  constantly  over  the  thighs,  the 
urine  kept  these  parts  repulsively  soiled  and  excoriated  and 
the  tail  wet  and  filthy. 

The  treatment  of  purulent  cystitis  consists  essentially  of 
the  disinfection  of  the  vagina,  vulva  and  bladder.  This 
should  l)c  accoinplislu'd  chiclly  by  the  niechauit-al  r(Mii()\al  of 


Vulvar  Diseases  813 

the  infections  and  of  the  purulent  exudates,  the  precipitated 
urinary  salts  and  other  debris,  by  the  use  of  physiologic  salt 
solution,  or  other  neutral  fluid  followed  by  non-irritant  anti- 
septics (iodoform,  bismuth)  suspended  in  bland  oil  or  in- 
corporated in  suppositories  of  wax  or  low-melting  paraffin. 

7.  Vulvar  Diseases 

The  vulva  of  the  mare  not  infrequently  suffers  from  in- 
juries during  parturition  which  lead  later  to  important 
infections.  Parturient  hematoma  of  the  vulva  are  common. 
Usually  the  blood  clots  are  submucous  and,  when  opened, 
heal  without  serious  infection.  Not  all  cases  terminate  so 
fortunately.  When  parturient  abrasions  are  severe,  infec- 
tion of  an  important  type  is  always  to  be  feared  and  should 
be  anticipated  by  taking  proper  antiseptic  measures.  It  is 
highly  important  when,  following  abortion,  the  fetal  mem- 
branes are  retained  and  lie  in  contact  with  parturient  abras- 
ions, that  special  precautions  should  be  taken  as  in  retained 
fetal  membranes  in  cows,  and  everything  possible  done  to 
avoid  serious  bacterial  invasion. 

Twice  I  have  observed  vulvar  gangrene  in  the  mare  fol- 
lowing dystocia  when  the  fetus  was  in  the  anterior  presenta- 
tion, dorso-sacral  position,  and  the  two  posterior  limbs  ex- 
tended underneath  the  body,  engaged  beneath  the  fetal  chest 
within  the  maternal  pelvis.  This  caused  the  fetus  to  become 
tightly  jammed  in  the  pelvis,  where  it  pressed  upon  the  in- 
ternal pudic  vessels  and  apparently  caused  a  pressure  or 
anemia  necrosis,  leading,  in  one  case,  to  rapid  sepsis  and 
death.  In  the  other  case  the  gangrene  caused  vulvar  atresia 
and  prevented  breeding.  Since  in  each  instance  the  dystocia 
developed  at  night  and  was  not  discovered  until  morning, 
the  perilous  pressure  upon  the  soft  parts  had  been  continued 
for  a  long  period  of  time.  When  such  injuries  occur,  the  vet- 
erinarian should  anticipate  vulvitis  by  means  of  warm 
douches  with  massage,  and  such  other  measures  as  may  sug- 
gest themselves  in  the  particular  case.  It  is  to  be  remem- 
bered that  fatal  gangrene  is  at  least  possible,  and,  while 
probably  preventable  by  the  application  of  vigorous  anti- 
septic measures,  is  not  ordinarily  curable. 


III.  CONGENITAL  INFECTIONS  OF  FOALS 

The  basic  principles  that  any  infections  existing  within 
the  gravid  uterus  may  invade  the  embryo  or  fetus,  and  may, 
if  they  fail  to  kill  the  intra-uterine  young,  persist  in  the  new- 
born and  cause  fatal  or  dangerous  illness,  apply  with  the 
same  force  in  foals  as  in  other  mammals.  The  manifesta- 
tions of  intra-uterine  infection  in  the  foal  present  interest- 
ing variations  in  clinical  behavior  without  violating  any 
fundamental  principle. 

A.    Septicemia  of  the  Foal 

When  an  equine  fetus  becomes  critically  infected  but  is 
born,  it  is  weak,  listless,  can  not  get  up,  and,  if  helped  to  its 
feet,  may  be  unable  to  stand.  If  born  unattended  and  a 
fragment  of  amnion  chances  to  be  upon  its  nose,  perhaps  it 
is  too  weak  to  free  itself  and  dies  with  the  frail  membrane 
lying  over  or  about  its  nostrils,  leading  to  the  popular  error 
that  foals  often  smother  in  the  amnion.  While  a  moribund 
foal  may  so  perish,  such  an  occurrence  with  a  healthy  foal 
is  extremely  improbable.  No  studies  have  been  made  of  the 
temperature  of  the  new-born  foal  suffering  from  septicemia, 
but  it  is  probably  elevated.  The  sepsis  generally  ends  fatally 
within  a  few  to  twenty-four  hours  and  the  post  mortem 
study  reveals  substantially  the  same  lesions  as  those  ob- 
served in  calves. 

B.  Retention  of  the  Meconium 

Calves,  and  most  other  new-born  mammals  which  bear  se- 
rious infection  from  the  uterus,  generally  show  a  marked 
and  early  tendency  to  dysentery.  In  harmony  with  the  nor- 
mal dryness  of  the  feces  in  the  large  intestines  and  rectum, 
alike  of  the  fetus  and  of  the  adult,  the  foal  often  shows  a 
pathologic  impaction  of  the  rectum  with  very  hard  masses 
of  meconium.  At  first  the  foal  may  appear  healthy  or  at 
most  merely  a  trifle  dull,  but  after  taking  milk  there  appear, 
at  from  Iweho  to  forty-eight  hours  after  birth,  symptoms 


Dysentery  815 

of  abdominal  pain.  This  is  expressed  in  part  by  turning  the 
nose  to  the  abdomen,  kicking  at  the  belly,  lying  down  and 
rolling.  The  most  characteristic  symptom  is  the  assumption 
by  the  foal  of  a  peculiar  extended  attitude  while  standing. 
The  foal  extends  its  anterior  feet  far  forward,  its  hind  feet 
backward,  all  members  being  held  rigid.  This  position  is 
maintained  for  five  to  fifteen  minutes  or  more.  The  layman 
believes  the  foal  is  attempting  to  urinate,  but  it  makes  no 
actual  effort  either  to  urinate  or  to  defecate.  The  tarsus  is 
not  bent  as  in  urination.  The  pain  is  intermittent.  Between 
paroxysms  the  foal  may  suck.  Unless  medical  relief  is 
given,  the  disease  pursues  a  slow  course  and  ends  in  death 
from  sepsis  and  exhaustion.  In  the  presence  of  meconic  re- 
tention, the  foal  often  develops  a  perverse  appetite  and  swal- 
lows large  quantities  of  hay,  straw,  feces  or  other  indigesti- 
ble substances,  thereby  complicating  the  disease  present. 

C.    Dysentery 

Some  writers  have  stated  that  retention  of  the  meconium 
frequently  ends  in  dysentery.  This  I  have  not  observed. 
Dysentery  is  not  rare  in  foals,  however,  and,  as  in  calves, 
may  be  due,  and  usually  is  due,  to  intra-uterine  infection, 
but  may  and  does  arise  from  extrinsic  infection,  variously 
obtained  after  birth.  The  symptoms  of  dysentery  in  foals 
are  essentially  parallel  to  those  described  in  calves.  Like 
calves,  foals  exhibit  a  strong  tendency  to  swallow  hay,  straw, 
feces  and  various  indigestible  substances.  These  complicate 
and  intensify  the  disease,  frequently  rendering  it  unavoida- 
bly fatal.  The  course  of  the  disease  may  be  either  rapid  or 
slow.  The  mortality  is  high  unless  active  measures  are  taken 
for  its  control.  The  behavior  of  the  disease  as  related  to  the 
feeding  of  milk  has  not  been  investigated,  but  is  presumably 
parallel  to  the  observations  made  upon  calves  and  previously 
described. 

D.  Arthritis.    Pyemia 

Pyemic  arthritis  is  commoner  in  foals  than  in  any  other 
species  of  domestic  animals.   This  is  due  chiefly  to  the  fact 


8i6  Diseases  of  the  Genital  Orirans 

that  a  large  proportion  of  the  cases  is  caused  by  post-natal 
infection  through  the  umbilicus  (omphalo  phlebitis,  pyo- 
septicemia),  owing  to  the  longer  and  thicker  umbilic  cord 
which  breaks  with  a  longer  stump.  An  important  part  is 
played  by  the  long  stump  by  inviting  imprudent  ligation,  so 
that  the  umbilic  stump  is  ligated  more  frequently  in  the  foal 
than  in  all  other  new-born  animals  combined.  Umbilic  in- 
fection is  so  evidently  the  cause  of  many  cases  of  pyemic 
arthritis  that  until  quite  recently  the  navel  was  considered 
the  sole  avenue  of  invasion.  Lately  Schofield'  has  shown 
satisfactorily  that  arthritis  is  frequently  due  to  intra-uter- 
ine  infection  and  that  in  etiology  it  conforms  to  the  basic 
principles  of  pyemic  arthritis  in  calves  and  may  be  either 
ante-natal  or  post-natal  in  origin.  Like  arthritis  in  calves, 
the  arthritis  of  foals  is  prominently  associated  with  intense 
intra-uterine  infection  in  mares  with  abundant  sterility  and 
abortion.  Bacteriologically  there  are  recognized,  in  the  in- 
fected joints  or  other  pyemic  centers,  streptococci,  staphy- 
locci,  the  B.  ahortivo-equinus,  etc.  In  other  words,  there 
may  be  present  in  the  diseased  joints  any  bacteria  which 
may  exist  (a)  in  the  uterine  cavity  of  the  pregnant  mare 
and  may  be  swallowed  by  the  fetus,  (b)  in  the  milk  of  the 
dam  and  be  swallowed  by  the  foal  when  the  alimentary 
epithelium  has  been  damaged  or  destroyed,  or  (c)  externally 
and  invade  the  foal  through  the  umbilicus. 

The  symptoms  consist  chiefly  of  the  sudden  development 
of  an  intense  arthritis  in  one  or  more  articulations,  most 
commonly  the  tarsus,  carpus  and  stifle.  When  the  invasion 
occurs  through  the  umbilicus,  the  event  is  usually  recorded 
locally  by  slight  swelling  of  the  umbilicus,  followed  pres- 
ently by  a  discharge  from  the  umbilic  veins  of  a  thin,  wa- 
tery pus  often  associated  with  a  re-opening  of  the  urachus 
with  flow  of  urine. 

Prior  to  the  definite  appearance  of  arthritis,  there  is  pres- 
ent a  marked  elevation  of  temperature  which,  as  in  the  calf, 
presages  the  approach  of  a  storm.  When  the  foal  is  one  to 
several  days  old,  there  develop  suddenly  centers  of  pyemic 

'Sch()(ic-l(l,    !••.    W.      InvrsliK.ilioiis    int..    |..inl  111    in    I'oals.       Dri.t.    A-r. 

Toronto,     \^)l(^. 


Arthritis.      Pyemia 


817 


inflammation,  chiefly  in  the  joints.  The  foal  is  seen  appar- 
ently well,  and  two  or  three  hours  later  is  found  breathing 
rapidly,  greatly  dejected,  lying  down  most  of  the  time  and, 
when  caused  to  rise  or  helped  up,  is  unable  or  unwilling  to 
bear  weight  upon  a  limb.  The  lameness  may  shift  to  another 
limb  very  abruptly  or  may  visibly  affect  one  or  more  joints 
in  two  or  more  members.  The  appetite  is  diminished  or  de- 
stroyed. The  involved  articulations  are  swollen,  hot  and 
painful.  The  synovial  sac  is  tightly  distended  with  reddish 
synovia,  which  may  later  become  purulent.  Pyemic  ab- 
scesses may  develop  in  any  organ  or  tissue. 

Pyemic  arthritis  is  commonly  associated  with  alimentary 


Fig.  232— Abscess  of  Umbilic  Vein  and  Artery.  Foal. 
B,  Urinary  bladder  ;  U,  umbilic  vein  passing  from  umbilicus  iuto  perito- 
neal cavity  ;  UA,  ends  of  ruptured  uterine  arteries  retracted  to  fundus  of 
bladder;  /^K,  umbilic  vein.  /,  Pus  cavity  in  umbilic  vein  ;  i-,  abscess  in 
right  umbilic  artery  ;  j,  thickened  walls  of  left  umbilic  artery  ;  /,  normal 
artery  ;  5,  thrombus  in  posterior  aorta  and  iliacs. 

disturbances  ranging  from  severe  diarrhea  to  obstinate  con- 
stipation, and  as  a  part  of  these  disturbances  there  develops 
an  erratic  appetite  which  causes  the  foal  to  swallow  hay, 
straw  and  other  indigestible  materials.  Unless  the  course 
of  the  disease  is  interrupted  by  vigorous  medical  interfer- 
ence, it  is  highly  mortal.  Almost  all  severe  cases  arising 
within  two  or  three  days  after  birth  are  fatal.  Many  are 
left  with  disabling  joint  lesions. 

The  lesions  vary  widely.  When  the  invasion  occurs 
through  the  umbilicus,  especially  when  aggravated  by  liga- 
tion of  the  umbilic  stump,  prominent  lesions  of  the  umbilic 
arteries  and  veins  are  probable,  as  shown  in  Fig.  232.  When 
these  vessels  become  involved,  the  urachus  ordinarily  par- 
52 


8i8 


Diseases  of  the  Genital  Organs 


ticipates  in  the  pathologic  processes,  the  retracted,  closed 
canal  re-opens  and  urine  dribbles  from  the  umbilicus.  It 
is  not  essential,  however,  that  the  infection  shall  invade  the 
system  through  the  umbilicus  in  order  to  cause  the  umbilic 
lesions.  There  is  clearly  a  bacteriemia  present.  The  re- 
cently ruptured  veins,  arteries  and  urachus,  with  retraction 
of  urachal  and  arterial  stumps  into  the  abdomen  and  maim- 
ing of  the  tissues,  afford  an  inviting  field  for  the  entrance 


^;^^.. 


/ 


^»c^ 


ViGS.  233,  234— Arthritis  of  Carpus. 

233 — Longitudinal  section  through  carpus. 

A,  Intra-articuhir  abscesses  ;   B,  pre-carpal  abscess  ;    C,  post-carpal  abscess. 

234— Cross  section  of  233  showing  articular  surfaces  of  carpal  bones. 

AB,  Purulent  destruction  of  articular  cartilage. 

of  bacteria  from  the  blood  stream  as  well  as  from  the  ex- 
terior. The  opportunity  for  bacterial  invasion  from  the 
blood  stream  is  further  favored  by  the  presence  of  some  ne- 
crotic blood  which  escaped  into  the  umbilic  connective  tis- 
sue during  the  retraction  of  the  umbilic  arteries.  An  even 
more  dangerous  condition  exists  in  the  umbilic  vein,  where 
some  residual  blood  invites  bacteria  and,  if  in  addition  the 
umbilic  stump  has  been  ligated,  the  entire  functionless  um- 
bilic veins  are  distended  with  great  masses  of  blood  incar- 
cerated by  the  ligature.  The  articular  lesions  consist  chiefly 
at  first  of  intense  synovitis  with  great  distension  of  the 
synovial  sac.  There  follow  later  necrosis  and  erosions  of 
the  articular  cartilages,  as  shown  in  Figs.  238  and  234.  The 
synovia  may  bo  bloody  and  (ui'bid.  and  may  contain  syno\ial 


Arthritis.     Pyemia 


S19 


820  Diseases  of  the  Genital  Organs 

clots  or  become  purulent.    The  necrosis  may  extend  to  the 
bones,  as  illustrated  in  Fig.  235. 

E.    Re-Opening  of  the  Urachus 

The  closing  of,  the  urachal  stump,  when  it  retracts  into 
the  abdomen  immediately  after  the  rupture  of  the  navel 
cord,  is  ordinarily  secure.  It  is  brought  about  partly  by 
the  thickening  oi  the  walls  of  the  tube  in  the  process  of 
shortening,  partly  by  the  retraction  of  the  surrounding  con- 
nective tissue  sheath,  and  apparently  also  by  lymph  poured 
out  from  the  lacerated  walls  at  the  point  of  rupture.  If  the 
urethra  is  open  and  the  umbilicus  escapes  infection,  no 
urine  escapes  from  the  umbilicus.  If  infection  invades  the 
wounded  umbilic  tissues  and  the  urachal  stump  is  involved, 
the  urachal  canal  re-opens  and  urine  flows  from  the  navel. 
Apparently  it  does  not  matter  whether  the  invasion  is  ex- 
trinsic or  intrinsic,  the  re-opening  of  the  urachus  follows. 
The  umbilicus  then  becomes  saturated  and  infiltrated  with 
urine  and  much  decomposition  results.  It  has  been  assumed 
generally  that  in  these  cases  the  urachus  has  failed  to  close, 
but  according  to  my  observations  the  open  urachus  (assum- 
ing the  urethra  is  open)  is  uniformly  secondary  to  infec- 
tion and  never  primary. 

The  handling  of  this  group  of  infections  has  not  been  well 
standardized.  Fundamentally  the  principles  involved  are 
identical  with  those  applying  to  calves.  The  rule  laid  down, 
that  the  sole  guarantee  for  the  birth  of  a  sound  calf  is  de- 
pendent upon  the  mating  of  sound  parents,  is  equally  appli- 
cable to  horsebreeding. 

It  is  essential  to  the  safety  of  a  new-born  foal  that  the 
expulsion  of  the  meconium  should  be  caused  as  completely 
and  early  as  practicable.  The  safest  means  is  the  high 
enema,  as  recommended  for  calves.  The  enemas  should  be 
repeated  at  least  twice  daily  until  the  expulsion  is  complete 
and  soft  meconium  is  passed.  When  meconic  retention  bo- 
comes  evident,  it  should  be  attacked  vigorously.  The  enemas 
of  physiologic  salt  solution  should  be  frequent  and  as  high 
as  practicable.     Olive  or  cottonseed  oil,  or  liquid  paraltin 


Re- opening  of  the  Urachus 


821 


may  be  substituted  for  the  salt  solution  or  may  be  given  per 
mouth.  If  these  fail,  resort  may  be  had  to  1/20  to  1/12 
grain  of  eserin  or  arecolin  given  hypodermically,  repeated 
hourly  if  needed.  In  the  meantime  the  foal  should  be 
watched  and  any  tendency  to  swallow  hay  or  bedding  frus- 
trated by  muzzling.  Although  not  investigated,  it  is  not 
improbable  that  the  hypodermic  injection  of  the  blood  serum 
or  defibrinated  blood  of  the  mother  of  the  foal  in  retention 
of  the  meconium  would  have  the  same  value  as  in  arthritis. 

The  feeding  of  foals  should  be  upon  the  same  principles 
as  that  of  calves.  When  a  foal  is  born,  the  precaution  should 
at  once  be  taken  to  draw  all  milk  from  the  mare's  udder  in 
order  that  it  shall  not  gorge  itself.  If  abortion  in  mares,  or 
dysentery  or  arthritis  of  foals  is  prevalent  in  the  establish- 
ment, the  development  of  the  two  latter  should  be  antici- 
pated and  vigorous  measures  taken  to  frustrate  them. 
Schofield'  has  reported  favorably  upon  the  use  of  bacterins 
made  from  the  streptococcus,  usually  found  by  him  in  the 
joint  lesions,  for  the  prevention  and  cure  of  arthritis.  He 
and  others  state,  however,  that  in  outbreaks  associated  with 
much  abortion,  the  B.  abortivo-equinus  is  present  in  the 
joints  and  appears  to  be  the  causative  agent.  In  such  case 
that  bacillus  needs  to  be  added  in  the  making  of  the  bac- 
terins. 

Forssell,  in  the  Berliner  Tierarztliche  Wochenschrift,  part 
12,  1916,  and  in  a  later  contribution  not  yet  published,  ad- 
vocates what  appears  to  be  a  more  logical  plan  for  prevent- 
ing and  handling  arthritis  in  foals  (and  probably  dysentery 
as  well),  by  the  use  of  the  blood  of  the  foal's  dam.  His 
recommendations  have  excellent  support  in  clinical  data. 
In  the  Schofield  plan  the  results  are  technically  based  upon 
the  causative  agent's  being  used  for  the  making  of  bacter- 
ins. The  causative  agent  is  subject  to  such  a  wide  variation 
in  species  that  the  selection  of  bacterins  is  always  a  hazard. 
Any  pyogenic  bacteria  which  may  exist  within  the  gravid 
uterus  or  which  may  invade  the  foal  through  the  umbilicus, 
may  cause  the  disease.    In  each  case  the  possible  number  of 

^Schofield,  F.  W.  Investigation  into  Joint-TU  in  Foals.  Dept.  Agr. 
Toronto,  1916. 


822  Diseases  of  the  Ge?iiial  Organs 

bacteria  which  may  serve  to  cause  the  disease  is  unknown 
and  unestimated. 

So  far  as  known,  the  blood  of  the  dam  always  carries  an- 
tibodies to  the  infections  present  in  her  uterus.  The  blood 
of  the  fetus  does  not,  with  rare  exceptions,  carry  such  anti- 
bodies, but  the  bacteria  of  the  uterus  exist  in  the  meconium 
of  the  fetus,  ready  after  birth  to  penetrate  the  alimentary 
mucosa  and  cause  septicemia  or  arthritis.  If  the  blood  of 
the  mother  is  used  as  a  prophylactic  or  therapeutic  agent, 
it  is  virtually  certain  that  antibodies  against  all  intra-uter- 
ine  infections  are  included.  It  does  not  assure  the  inclusion 
of  antibodies  against  extrinsic  or  navel  infection.  The  pro- 
phylaxis of  this  may  be  attained,  however,  by  the  proper 
disinfection  of  the  navel  stump  when  the  foal  is  born.  At 
the  same  time,  the  blood  of  the  mare  probably  contains  anti- 
bodies against  the  most  common  infections  invading  the 
navel. 

Forssell  at  first  used  the  blood  serum  from  the  dam,  but 
found  this  objectionable  because  it  involved  a  delay  of  one 
day,  which  is  very  undesirable  in  the  most  violent  cases.  He 
then  turned  to  the  Lewisohn  method  of  using  the  entire 
blood.  He  found  that,  by  adding  neutral  sodium  citrate, 
two  parts  to  one  thousand  parts  of  blood,  horse  blood  will 
not  coagulate.  The  uncoagulated  blood  may  be  given  safely 
intravenously  or  subcutaneously.  The  technic  of  Forssell 
directs  that  first  the  phlebotomy  needle,  the  vessel  for  the 
blood,  the  hypodermic  syringe,  and  other  apparatus  should 
be  boiled.  The  water  used  for  boiling  these  needs  to  be  free 
from  lime,  because  any  of  this  coming  in  contact  with  the 
blood  causes  coagulation  despite  the  presence  of  sodium 
citrate. 

When  ready  to  draw  the  blood,  one  gram  of  sodium 
citrate  in  fifty  grams  of  water  is  placed  in  a  fiask  or  other 
container  and  shaken  about  until  the  sides  of  the  vessel  are 
well  moistened.  This  sufiices  to  prevent  the  coagulation  of 
500  cc.  of  blood,  which  volume,  or  a  trifle  less,  is  used  as  a 
sigle  dose.  While  the  blood  is  being  drawn,  it  needs  to  be 
agitated  constantly  or  stirred,  in  order  to  keep  it  mixed  with 


Re- opening  of  the  Urachns  823 

the  citrate  and  prevent  coagulation.  When  used  subcutane- 
ously,  it  should  be  injected  along  the  sides  of  the  neck  or 
chest,  about  50  cc.  at  a  given  point.  For  subcutaneous  use, 
Forssell  states  that  the  mixture  of  the  sodium  citrate  is  not 
absolutely  essential.  If  one  needle  is  in  the  vein  of  the  dam 
and  a  second  needle  is  already  in  place  for  the  subcutaneous 
injection,  the  blood  may  be  drawn  into  the  syringe  and 
quickly  injected.  The  needle  in  the  foal  is  then  moved  to 
another  point  and  the  syringe  again  filled.  The  syringe  must 
be  kept  warm  with  hot  water.  When  using  the  non-coagu- 
lated blood,  it  should  be  kept  at  body  temperature  by  im- 
mersing the  container  in  warm  water.  The  intravenous  in- 
jection must  be  made  very  slowly. 

Forssell  reports  157  cases  handled  with  the  dam's  blood  or 
blood  serum,  with  recoveries  in  127 — 81  per  cent.  Many  of 
those  which  died  were  in  a  critical  condition  when  the 
handling  was  begun,  and  more  would  probably  have  recov- 
ered had  the  application  been  made  earlier. 

Forssell  believes  that  the  ideal  plan  would  be  to  prepare  a 
stock  serum  from  the  bacteria  recognized  in  arthritis  which 
could  be  conveniently  and  promptly  given  the  foal.  The  ob- 
jection exists,  however,  that  the  bacteria  of  foal  septicemia, 
pyemia,  arthritis  and  dysentery  may  vary  widely,  and  that 
any  stock  serum  may  fail  to  contain  the  antibodies  for  the 
infection  causing  disease  in  a  given  foal.  On  the  other  hand 
it  is  to  be  remembered  that,  so  far  as  known  at  present,  the 
bacteria  causing  the  infections  in  new-born  foals  (except 
such  specific  forms  as  tetanus  bacilli  when  invading  the 
navel)  including  the  B.  ahortivo-equinus,  are  identical  with, 
or  analogous  to  the  common  wound  infections,  and  that 
many,  perhaps  most  of  them,  are  normal  habitants  of  the 
adult  body,  either  in  the  alimentary  tract,  in  the  udder,  or 
in  the  genital  organs.  Consequently  the  blood  of  an  adult 
horse  may,  and  perhaps  does,  contain  a  long  list  of  anti- 
bodies which  confer  upon  the  animal  a  degree  of  resistance 
to  the  entire  bacterial  group  involved — age  resistance.  In 
discussing  calf  scours  serum,  it  was  noted  that  there  is  much 
evidence  tending  to  show  that  normal  horse  serum  possesses 


82  4  Diseases  of  the  Genital  Orga?is 

similar  therapeutic  power  to  the  artificially  produced  calf 
scours  serum.  If  this  proves,  upon  further  study,  to  be 
true,  it  would  logically  follow  that  the  blood  of  an  adult 
horse  would,  as  a  rule,  contain  valuable  antibodies  for  those 
common  or  non-specific  infections  menacing  the  life  of  the 
new-born  foal.  Another  interesting  possibility,  in  stables 
where  arthritis  and  dysentery  are  common,  is  that  blood 
may  be  drawn  from  mares  in  advanced  pregnancy  a  few 
days  prior  to  expected  parturition,  serum  prepared,  and 
with  0.5  per  cent,  phenol  added,  retained  in  a  refrigerator 
until  the  foal  is  born,  and  then  given  immediately. 

F.    Rupture  of  the  Tendons  and  Synovial  Distensions 

OF  THE  NEW-BORN   FOAL 

There  occurs  not  infrequently  an  interesting  and  usually 
mortal  disease  in  young  foals,  expressing  itself  clinically  by 
the  rupture  of  the  extensor  pedis  longus  tendons,  and  by  dis- 
tension of  the  synovial  cavities,  especially  of  the  great  femo- 
ro-tibio-patellar  synovial  sac.  The  character  of  the  disease 
is  as  yet  unknown.  It  is  unquestionably  intra-uterine  in 
origin.  The  symptoms  become  obvious  within  one  to  several 
days  after  birth.  It  is  placed  among  the  intra-uterine  in- 
fections, not  so  much  because  of  evidence  of  its  infectious 
nature,  as  because  its  etiology  is  unknown  and  because  cer- 
tain clinical  facts  vaguely  suggest  that  it  is  due  to  infection. 
I  have  observed  the  disease  mostly  in  localities  where  uter- 
ine infections  of  mares  are  common.  In  one  stable  under 
my  care,  there  were  born  two  foals  annually  for  two  years 
and  each  of  the  four  foals  suffered  from  rupture  of  both  ex- 
tensor pedis  longus  muscles.  The  symptoms  observed  con- 
sist essentially  of  loss  of  power  to  extend  the  carpus.  When 
born  the  foal  shows  nothing  notable  so  far  as  yet  observed, 
except  that  there  is  apparent  feebleness.  It  gets  up  or.  if 
unable  to  do  so,  stands  when  helped  to  its  feet,  but  walks  un- 
steadily, the  carpus  constantly  tending  to  bend  forward. 
There  is  no  recognizable  anatomical  defect  in  the  carpus 
such  as  the  ordinary  bent  carpus  often  seen  in  new-born 
foals.  The  entire  cause  of  the  symptoms  appears  to  be  in  the 


Rupture  of  the  Tendons  of  the  Xcw  Born  Tool 


82  s 


chief  extensor  of  the  foot.  The  carpus  is  bent  forward,  as 
shown  in  Fig.  236.  If  the  foal  is  helped  to  its  feet  and  pres- 
sure applied  against  the  anterior  face  of  the  carpus,  it 
stands  steadily  and  the  carpus  is  straight,  but  removal  of 
the  pressure  permits  the  carpus  to  bend  forward  and  may 
cause  the  foal  to  fall.  As  the  disease  progresses  the  foal 
shows  decreasing  control  over  the  anterior  feet,  and  in  the 


Fjc;.  23b— Rupture  of  Extensor  Tendons  at  Carpvis,  and 
Floating  Dislocation  of  Patella. 

a.  Patella;    />,  feiiioro-iihial  arliculation. 

most  severe  cases  becomes  unable  to  rise  and  even  unable  to 
stand  when  helped  up.  When  the  decubitis  becomes  con- 
stant, the  foal  generally  perishes  within  a  few  days. 

Apparently  an  integral  part  of  the  malady,  but  infre- 
quently seen,  is  the  distension  of  the  femoro-tibio-patellar 


826 


Diseases  of  the  Cieyiiial  Organs 


sj-novial  sac,  as  shown  in  Fig.  236.  The  two  synovial  cavi- 
ties became  so  distended,  when  the  foal  was  two  or  three 
days  old,  that  each  patella  was  pushed  away  from  the  troch- 
lear groove  of  the  femur,  floated  above  the  summit  of  the 
external  ridge,  and  became  completely  dislocated  laterally, 
wholly  disabling  the  posterior  limb.  The  foal  was  therefore 
unable  to  stand  erect  either  before  or  behind.  The  disease 
is  apparently  not  local,  but  merely  the  local  evidence  of  sys- 
temic disturbances.     In  lying  down  and  getting  up,  the  ex- 


FPA 


rig.  237— Rupture  of  the  Extensor  Pedis  Long-us  Muscle 

in  New-Born  Foal. 

Right  anterior  liiiih  st-fu  fri>iii  in  front. 

E^r,    Ivxtensor  niL-tacarpus  ;    El\   extensor  ])e(lis  lon,L,'ns  ;   EPA,  extensor 

jjedis  lonj^ns  accessorius  ;   /,  Proxitual  rnptnreii  end  ;  2,  distal 

portion  of  tendon  dropped  down  in  sheath,  j. 


Rupture  of  the  Tendons  of  the  Neiv-Born  Foal  827 

tremely  long  legs  of  the  foal  lead  to  an  inordinate  strain 
upon  the  extensor  pedis  longus  muscle.  The  rupture,  as 
shown  in  Fig.  237,  occurs  at  the  point  of  union  between  the 
tendon  and  the  belly  of  the  muscle.  In  this  respect  it  differs 
markedly  from  the  ruptures  of  muscles  and  tendons  com- 
monly observed. 

The  clinical  evidences  of  a  rupture  rests  in  the  early  stages 
upon  the  difficulty  or  inability  of  the  foal  to  get  up  or  to  walk 
because  of  the  want  of  power  to  extend  the  carpus.  If  the 
character  of  the  lesion  is  suspected,  the  diagnosis  is  to  be 
verified  by  carefully  palpating  over  the  anterior  face  of  the 
lower  third  of  the  radius,  from  1  to  2  in  Fig.  237,  which  re- 
veals an  empty  groove  normally  occupied  by  the  base  of  the 
tendon,  2.  The  free  end  of  the  tendon  is  also  palpable,  freely 
movable  in  its  sheath  at  the  upper  part  of  the  carpus.  In 
those  animals  which  survive,  reunion  between  the  muscle 
and  tendon  does  not  occur  and  the  empty  groove  is  perma- 
nent. The  foot  must  then  be  advanced  by  the  accessory  ex- 
tensor of  the  metacarpus.  This  results  in  a  peculiar  gait, 
the  foot  being  abducted  in  the  stride  and  carried  forward 
with  a  jerky  flail-like  motion. 

The  prognosis  is  exceedingly  unfavorable.  Although 
some  cases  live,  their  locomotion  is  interfered  with  by  the 
absence  of  the  extensor  pedis  longus  muscles,  and  the  value 
of  the  animals  is  consequently  greatly  lessened  except  for 
slow  work.  For  driving  or  riding  they  would  inevitably 
prove  insecure  upon  their  feet.  For  any  fashionable  use, 
their  peculiarity  of  action  would  render  them  unsuitable. 

The  handling  of  the  malady  is  uncertain,  and  apparently 
there  is  little  to  do  beyond  taking  good  care  of  the  animal 
and  aiding  it  in  getting  upon  its  feet  in  order  to  suck.  While 
the  foal  is  sucking,  an  assistant  should  grasp  it  by  the  knees, 
and,  pushing  backward,  prevent  their  flexion,  thereby  as- 
sisting it  in  standing.  Unless  the  foal  is  of  considerable 
value,  it  is  advisable  in  most  instances  to  destroy  it  at  once. 


SECTION  V.      THE  GENITAL  INFECTIONS 
OF  CARNIVORA 

CHAPTER  XXIV 

SPECIFIC  VENEREAL  DISEASES 

The  Venereal  Tumors  of  the  Dog.  Venereal  Granulo- 

MATA.      LYMPHO-SaRCOMA 

In  the  dog,  there  is  observed  a  specific  venereal  disease 
consisting  of  granulomata  upon  the  genital  mucosa.  The 
disease  is  somewhat  wide-spread  in  Great  Britain  and  con- 
tinental Europe.  It  is  observed  in  various  portions  of  the 
United  States,  largely  in  dogs  recently  imported.  In  the 
male  it  aff'ects  chiefly  the  penis  and  prepuce  and  sometimes 
invades  the  adjacent  tissues.  Metastatic  disease  of  the  in- 
guinal glands  may  follow.     In  the  female  it  involves  pri- 


I'K..  2T,S     Infectious  Venereal  Granuloma  of  Dog.     (C.  A    WhiU-. ) 

marily  and  chiefly  the  vulva.  It  is  naturally  transmitted  by 
copulation  only,  but  may  be  otherwise  spread  by  artificial 
or  accidental  inoculation. 


The  Venereal  Tioiiors  of  Dogs 


829 


Symptoms.  The  first  symptom  usually  noted  is  a  bloody 
discharge  from  the  prepuce  or  vulva,  accompanied  by  tume- 
faction of  the  parts.  If  the  penis  is  exposed  at  this  time, 
there  are  seen  pink  or  grayish  red  vegetations,  largely  upon 
the  glans  or  at  the  preputial  ring  upon  which  the  glans  rests 
when  the  penis  is  retracted,  at  times,  upon  other  parts  of 
the  mucosa.    The  tumors  are  soft  and  friable  and  bleed 


Fig.  239— Infectious  Venereal  Granuloma  of  Bitch.     ( C.  A.  White. ) 

freely  upon  being  touched.  They  may  be  sessile  or  some- 
what pedunculated,  resembling  warts.  The  affection  is  of 
a  chronic  character  and  seems  to  have  no  definite  limitation. 
The  vegetations  continue  to  increase  in  size  month  by  month 
and  finally  become  firm,  lobulated  masses,  so  intensely  in- 
jected that  they  assume  a  dark  color. 


830 


Diseases  of  the  Genital  Organs 


In  the  bitch,  the  symptoms  are  very  similar.  There  is 
first  a  bloody  discharge  from  the  vulva.  Examination  of 
the  vulva  and  vagina  reveals  vegetations  of  the  same  ap- 
pearance as  already  noted  in  the  male.  These  appear  chiefly 
along  the  floor  of  the  vulva  and,  when  very  large,  may  pro- 
trude externally.  The  discharge  from  the  vulva  is  usually 
fetid.  According  to  French,  males  sometimes  show  an 
aversion  to  mating  with  affected  females. 


Fig.  240 — Infectious  Venereal  Granuloma  of  Bitch.     (C.  A.  White.) 

Beebe  and  Ewing  (Jour.  Med.  Research,  Sept.,  190G.  do. 
Vet.  Jour.,  July,  1907)  record  the  presence  in  these  tumors 
of  spirochaete  in  one  out  of  a  series  of  cases,  but  failed  to 
connect  their  presence  with  the  cause  of  the  malady. 

Later,  Mettam  (Veterinary  Journal,  February,  1907)  re- 
cords the  discovery  of  an  organism  in  this  disease  belong- 
ing to  the  group  of  spirochaete,  which  he  believes  to  be  the 
specific  cause. 


The  Vefiereal  Tumors  of  Dogs  831 

Histologically,  the  tumors  consist  of  large  round  or  polyg- 
onal cells,  which  multiply  rapidly  and  push  the  contiguous 
tissues  aside  without  their  becoming  involved  in  inflamma- 
tory or  other  disease  changes. 

The  disease  has  been  repeatedly  transmitted  experiment- 
ally by  inoculations  in  the  genital  mucosa  and  other  tissues. 

In  clinical  and  experimental  cases  the  neoplasms  may  not 
remain  confined  to  the  genital  organs,  but  may  involve  the 
skin,  the  lymphatic  glands  of  various  portions  of  the  body, 
the  liver,  spleen  and  other  glands. 

The  treatmeyit  is  not  highly  satisfactory  unless  undertaken 
early.  It  consists  chiefly  of  excising  the  vegetations,  along 
with  a  small  area  of  the  healthy  mucosa,  after  which  the 
edges  of  the  wound  should  be  drawn  together  with  catgut. 

In  the  male,  it  may  be  necessary  to  divide  the  prepuce 
and,  in  the  female,  the  perineum,  in  order  to  reach  all  the 
diseased  parts.  Afterwards,  these  wounds  should  be  su- 
tured. It  is  well  to  place  the  animal  under  general  anaes- 
thesia for  the  operation,  which  should  be  repeated  within 
one  to  three  weeks  if  necessary,  and  in  some  cases  cautery 
may  be  used.  In  inveterate  cases  it  may  be  necessary  to 
amputate  the  penis  and  prepuce.  Hobday  states  that  the 
disease  may  be  favorably  affected  by  castration. 


CHAPTER  XXV 

THE  GENERAL  GENITAL  INFECTIONS 
OF  CARNIVORA 

Since  the  general  genital  infections  of  dogs  and  cats  have 
not  been  extensively  studied,  little  can  be  said  of  them.  It 
is  know^n  that  carnivora  suffer  frequently  and  seriously 
from  general  genital  infections,  but  their  individual  value 
is  so  low  in  many  cases,  and  so  few,  comparatively,  are 
valued  highly  for  breeding  purposes  that  this  group  of  dis- 
eases has  attracted  scant  attention. 

It  is  well  known  that  dogs  suffer  virtually  universally 
from  a  well  marked  genital  catarrh.  It  is  so  common  that 
it  is  designated  as  normal  and,  so  far  as  known,  has  had  no 
serious  study.  It  is  assumed  to  cause  no  important  harm. 
It  is  a  repulsive  disease  in  many  males,  as  the  genital  dis- 
charge soils  the  hairs  about  the  sheath  opening  and  attracts 
many  flies. 

The  bacterial  flora  of  the  genital  tract  is  quite  unknown. 
B.  abortus  (Bang)  has  been  recognized  in  the  genital  tract 
of  the  bitch  following  experimental  inoculation.  It  was  not 
known  that  the  bacillus  did  not  already  exist  in  the  bitch  at 
the  time  of  inoculation,  and  it  is  not  known  how  frequently 
the  B.  abortus  exists  naturally  in  either  dogs  or  cats.  Since 
both  feed  freely  upon  cow's  milk,  which  ordinarily  contains 
B.  abortus,  it  is  probably  a  common  habitant  of  the  organs 
of  carnivora.  The  infections  of  the  genitalia  of  carnivora 
probably  resemble  closely,  if  they  are  not  frequently  iden- 
tical with,  the  bacteria  invading  the  genitalia  of  other  spe- 
cies. At  least  they  behave  in  the  same  general  manner  and 
cause  the  same  clinical  phenomena. 

Little  is  recorded  concerning  the  infections  of  the  testicle 
and  epididymis  of  carnivora.  In  the  dog.  without  vesiculae 
seminales,  the  prostate  assumes  prominence  anatomically 
and  pathologically.  Prostatitis  is  a  common  malady  seen 
chiefly  in  adult  and  aged  dogs.  It  has  not  been  studied  ex- 
cept when  it  causes  clinical  symptoms  consisting  of  difli- 


The  General  Genital  Infections  of  Carnivora  833 

culty  in  defecation  and  urination.  It  naturally  renders  the 
ejaculation  of  semen  difficult.  How  much  danger  it  carries 
for  the  bitch  in  coitus  has  not  been  investigated.  It  may 
play  an  important  role  in  serious  abortion  storms  in  valu- 
able kennels.  When  clinical  prostatitis  of  a  marked  type  be- 
comes established,  as  in  semino-cystitis  in  bulls,  the  dog 
probably  becomes  sterile,  but  may  be  innocuous  because  the 
prostatic  ducts  are  occluded  and  the  infection  incarcerated. 

When  difficulty  in  defecation  or  urination  becomes  clini- 
cally evident,  palpation  per  rectum  reveals  the  presence  of 
the  enlarged  sensitive  prostate.  When  the  disease  has  so  far 
progressed  that  it  causes  clinical  discomfort,  it  is  probably 
beyond  repair  so  far  as  fertility  is  concerned.  There  re- 
mains only  the  question  of  prolonging  the  life  of  the  patient. 
In  this  field  little  of  value  has  been  accomplished.  Appar- 
ently prostatitis  has  attracted  no  attention  in  relation  with 
fertility  and  no  operation  or  other  method  of  handling  for 
this  purpose  suggested.  Castration  tends  to  cause  abate- 
ment in  the  symptoms  of  non-malignant  prostatitis.  Much 
of  the  prostatitis  is  malignant.  Prior  to  reaching  such  an 
advanced  stage,  careful  physical  examination  or  examina- 
tion of  the  semen  may  reveal  the  seriousness  of  the  infection 
and  enable  the  veterinarian  to  avert  disaster  to  valuable 
breeding  bitches. 

Diseases  of  the  ovary  are  apparently  less  common  than  in 
mares  and  cows.  I  observed  one  instance  of  nymphomania 
in  the  bitch,  associated  with  cystic  degeneration  of  the 
ovary,  as  shown  in  Fig.  241.  The  nymphomania  presented 
the  same  general  symptoms  as  in  the  cow  and  was  relieved 
by  castration.  There  are  no  data  recorded  suggesting  a 
hopeful  plan  for  handling  nymphomania  in  the  bitch  with  a 
view  to  the  restoration  of  fertility.  The  surgical  handling 
of  the  ovaries  would  call  for  laparotomy. 

The  infections  of  the  pregnant  uterus  of  the  bitch 
and  cat  are  numerous  enough,  but  the  details  of  their 
behavior  have  not  been  recorded.  In  some  kennels  the 
owners  report  that  over  a  long  period  of  time  essen- 
tially all  bitches   abort,   or   at   least  fail   to   produce   liv- 

53 


834 


Diseases  of  the  Genital  Organs 


ing  young.  When  abortion  is  reported,  its  exact  mean- 
ing is  not  clear.  Dystocia  in  carnivora  is  frequently, 
if  not  generally,  due  to  the  death  of  a  fetus  or  of 
fetuses  as  a  result  of  infection.  As  a  rule,  as  in  the  sow, 
the  basal  fetus — the  fetus  in  the  base  of  one  horn  and  near- 
est to  the  vagina — perishes  first  and  undergoes  emphysema- 
tous decomposition,  blocking  the  genital  passage.    The  dis- 


FiG.  241— Normal  and  Cystic  Ovaries  of  Bitch. 

.-/,  Cystic  ovary  ;    B,  noriual  ovary  with  the  pavilion  of  the  ovitluct  turned 

back  to  expose  the  ovary  ;    C,    normal  ovary  covered  by  the  pavilion 

of  the  tube,  showinjj  the  meatus  {M)   of  the  ovarian  sac,  by 

which  it  communicates  with  the  peritoneal  cavity. 

position  of  the  gravid  uterus  of  carnivora  is  typically  illus- 
trated in  Fig.  242.  The  basal  fetus  ordinarily  lies  in  the 
base  of  one  horn,  and  the  vaginal  end  of  its  fetal  sac,  instead 
of  protruding  into  the  cervix,  passes  across  the  uterine  end 
of  the  cervix  into  the  base  of  the  other  horn,  or  practically 
into  the  other  uterus,  since  the  bitch  has  virtually  a  double 
uterus,  the  two  organs  communicating  at  their  bases.  In 
this  manner,  from  ovary  to  ovary,  the  two  uterine  cavities 
arc  made  to  constitute  one  cDiitiiuious  tube  and  cvicli   iV'tal 


The  General  Genital  Infections  of  Carnivora  835 


Fig.  242— Gravid  Uterus  of  Bitch  In  Situ. 
U,  Direct  cornua  ;   U' ,  retrograde  portion  of  coriiu. 


836  Diseases  of  the  Genital  Organs 

sac,  except  of  the  two  apical  fetuses,  is  in  contact  at  each 
pole  with  the  next  fetal  sac.  The  two  apical  embryonic  sacs 
end  at  the  ovarian  pole  against  the  mouth  of  the  oviduct,  and 
at  the  cervical  pole,  against  the  next  embryonic  sac.  Since 
the  placentae  are  zonular,  infection  can  not  pass  directly 
along  the  uterine  tube,  but  must  pass  between  the  fetal  and 
placental  structures,  destroying  the  life  of  the  involved  em- 
bryo, or  must  pass  through  the  embryonic  sac  and  the  con- 
tained fluids  and  kill  the  embryo  more  directly.  In  either 
case  embryonic  death  would  necessarily  occur  one  after  an- 
other from  the  center  of  infection,  and  not  en  jnasse.  If, 
on  the  other  hand,  there  is  a  specific  infection  which  causes 
abortion  directly,  either  by  passing  from  the  blood  stream 
of  the  pregnant  mother  to  the  fetus  and  destroying  its  life, 
by  passing  from  the  blood  stream  into  the  interplacental 
areas  of  the  uterus  and  thence  through  the  chorion  and  am- 
nion to  destroy  the  embryo,  or  by  forming  bacterial  products 
anywhere  within  the  animal  body  which  are  able  to  act  di- 
rectly upon  the  uterus  and  cause  the  expulsion  of  its  con- 
tents, then  abortion  e?i  masse  would  occur  in  muciparous 
animals  such  as  swine  and  carnivora.  But  so  far  as  I  have 
been  able  to  observe  in  the  abattoir  or  to  learn  from  litera- 
ture, the  death  of  embryos  occurs  singly  and  seriatim  from 
one  or  more  centers  of  infection.  When  all  embryos  have 
perished,  or  the  last  to  become  involved  are  critically  ill,  the 
uterus  contracts  and  expels  its  contents.  Otherwise,  if 
some  embryos  have  not  been  mortally  infected,  they  continue 
their  development  and  inhibit  the  expulsion  of  any  fetal 
cadavers  present.  When  the  living  embryos  have  reached 
maturity  parturition  occurs  unless  the  outlet  is  blocked  by 
a  macerating,  emphysematous  cadaver.  Along  with  the 
young  which  are  born,  there  are  expelled  some  or  all  of  the 
fetal  cadavers,  or  their  debris.  If,  however,  an  apical  em- 
bryo is  dead  and  macerating,  all  others  may  be  expelled  and 
the  cadaver  remain  in  the  diseased  apex  of  the  horn  to  pro- 
duce a  persistent  pyometra. 

The  prevention  of  the  general  infections  of  the  genitalia 
of  carnivora  has  not  been  sutlic-iently  studied  to  porniit  tlie 


77/1?  General  Genital  Infections  of  Carnivora 


837 


formulation  of  a  plan.  Anatomical  limitations  prevent  the 
examinations  of  the  genitalia,  so  readily  applied  in  cattle 
and  horses.  The  testes  and  the  glands  of  the  pelvic  urethra 
of  the  male  are  palpable.  Conscientious  effort  should  de- 
velop a  technic  which  would  enable  the  veterinarian  to  ex- 
amine satisfactorily,  and  to  apply  remedial  measures  to,  the 
vagina,  cervix  and  uterus. 

The  clinical  evidences  of  embryonic  death  in  carnivora  are 
variable.  It  is  not  known  that  the  death  of  an  embryo  in- 
duces mammary  activity,  as  is  observed  in  the  mare  and 
cow.    If  the  basal  fetus  of  the  bitch  or  cat  is  healthy,  there 


Fig.  243 — Pyometra  and  Pyosalpinx.     Cat. 
/,  Ovarj- ;  2,  abscess  of  oviduct ;  j,  distended  cornua  ;  y,  cernx  ;  5,  bladder. 


838  Diseases  0/  the  Genital  Orgaiis 

can  be  no  genital  discharge  from  necrotic  embryos  located 
upon  the  ovarian  side  of  it.  What,  if  any,  general  symptoms 
are  caused  by  maceration  of  embryos  anterior  to  the  basal 
one  has  not  been  recorded.  If  pregnancy  is  well  advanced 
and  the  maceration  is  rapid,  there  should  be  signs  of  tox- 
emia and  blood  samples  should  reveal  pyogenic  activity. 

When  the  basal  fetus  becomes  necrotic,  genital  discharge 
may  occur;  the  probability  of  a  visible  discharge  increases 
as  pregnancy  advances.  The  discharge  is  generally  fetid, 
sometimes  evidently  purulent,  but  when  the  normal  dura- 
tion of  pregnancy  has  been  almost  or  quite  reached,  the  dis- 
charge is  usually  sanious  and  distinctly  repulsive.  Then 
there  are  clinical  evidences  of  sepsis  and  sometimes  appear- 
ances of  dystocia.  Parturition  is  suspected  rather  because 
of  the  existence  of  a  completed  pregnancy  and  of  a  genital 
discharge  than  because  of  definite  expulsive  efforts.  The 
uterus  about  the  necrotic  basal  fetus  is  often  too  paretic  to 
dislodge  the  cadaver  and  force  it  into  the  cervix  or  vagina, 
where  its  presence  would  cause  definite  expulsive  contrac- 
tions by  the  abdominal  walls.  Hence  the  veterinarian  diag- 
noses dystocia  due  to  a  macerating  fetus,  chiefly  from  the 
presence  of  the  clinical  symptoms  of  sepsis  (dullness,  lassi- 
tude, erratic  temperature,  weakness) ,  the  presence  of  a  geni- 
tal discharge,  and  the  knowledge  that  the  patient  is  preg- 
nant and  is  at  or  near  the  time  for  parturition.  If  to  these 
are  added  even  slight  expulsive  efforts,  the  diagnosis  is  fa- 
cilitated. In  the  advanced  stages  of  pregnancy,  the  hand- 
ling of  embryonic  death  calls  for  the  complete  evacuation  of 
the  uterus.  This  is  to  be  attained  chiefly  by  means  of  the 
administration  of  pituitary  extract  or  by  hysterotomy  or 
hysterectomy.  These  are  described  in  the  companion  vol- 
ume, Veterinary  Obstetrics. 

The  infections  of  the  uteri  of  carnivora  during  the  puer- 
peral and  post-puerperal  periods  offer  little  that  is  unusual, 
so  far  as  recorded.  The  greatly  elongated  and  sinuous  cor- 
nua  render  pyometra  very  obstinate.  The  discharge  is  often 
voluminous  and  extremely  fetid.  It  may  be  complicated  by 
retained  fetal  envelops  or  by  the.  presence  of  a  macerating 


Venereal  Disease  of  Rabbits  839 

fetus  in  the  apex  of  one  horn.  Occasionally  the  uterus  be- 
comes distended  similar  to  an  abscess,  as  shown  in  Fig.  243. 
In  the  absence  of  effective  technic  for  disinfecting  the 
uterus,  the  chief  reliance  is  to  be  placed  upon  hysterectomy. 
This  is  already  described  in  the  companion  volume. 


CHAPTER  XXVI 
VENEREAL  DISEASE  OF  RABBITS 

Friedberger  and  Frohner  (Spezielle  Pathologic  und  Ther- 
apie,  1904,  page  501),  describe  an  infectious  disease  of  rab- 
bits which  is  transmitted  chiefly  or  wholly  through  copula- 
tion. The  affection  appeared  in  an  extensive  breeding  es- 
tablishment of  rabbits.  It  consisted  of  an  inflammatory 
disease  of  the  organs  of  copulation.  It  was  transmitted  by 
coition  from  buck  to  doe,  and  vice  versa.  There  were  ex- 
tensive swellings  of  the  genital  organs  in  both  sexes,  accom- 
panied by  a  muco-purulent  discharge.  The  disease  was 
finally  eradicated  by  injections  of  a  solution  of  sulphate  of 
copper,  one  to  two  per  cent.,  extending  over  a  period  of  some 
weeks. 

This  or  a  very  similar  disease  occurs  in  large  breeding  es- 
tablishments of  rabbits  and  hares  in  this  country,  and 
causes  very  serious  losses  by  lowering  or  preventing  repro- 
duction over  a  long  period  of  time.  The  only  remedy  known 
is  the  thorough  disinfection  of  the  copulatory  organs  of  both 
sexes  and  the  suspension  of  breeding  until  the  disease  is 
under  control. 


INDEX  TO  ILLUSTRATIONS 

COLORED  PLATES 

Pirate  I.  Gravid  Uterus  of  Cow  at  full  term,  laid  open 
to  show  Fetal  Sac  with  faint  outline  of 
Fetus Frontispiece 

Plate  II.        Fetal  Sac  of  Cow  at  about  loo  days  ....  Opposite  page    66 

Plate  III.  Gravid  Uterus  of  Cow  at  about  four  months, 
showing  Abortion  Exudate  in  the  Non- 
Gravid  Horn Opposite  page    67 

Plate  IV.  Uterine  Cornu  of  Cow  laid  open  showing 
"Exudate  of  Contagious  Abortion"  in 
the  Utero-Chorionic  Cavity Opposite  page    68 

Plate  V.  Portion  of  Chorion  of  Cow,  showing  Diffuse 
(Adventitious)  Placenta  following  Necro- 
sis of   Cotyledons Opposite  page  474 

Plate  VI.       Cervicitis.     Cow Opposite  page  618 

Plate  VII.  Fetal  Death.  Ewe.  The  Uterus  is  laid  open 
to  show  the  Fetus  lying  in  Anterior  Pre- 
sentation,  Dorso-Sacral    Position  ....  Opposite  page  726 

Plate  VIII.   Abortion  and  Retained  Placenta  in  Ewe  .    .  Opposite  page  730 


ILLUSTRATIONS  IN  TEXT 

page 

Fig.  I.         The  Testicle  and  its  Attachments 3 

Fig.  2.         Testicles  of  Bull 5 

Fig.  3.         Cross  Section  through  Scrotum  and  Testicles  of  Bull  Calf  .  7 
Fig.  4.         Cross  Section  through  Scrotum  of  Young  Bull  viewed  from 

Posterior  Side                          8 

Figs.  5  &  6.  Glands  Attached  to  Pelvic  Urethra  of  Bull  viewed  from  above  1 1 

Fig.  7.         Same  as  Figs.  5  and  6  with  same  lettering 13 

Fig.  8.         Penis  of  Calf  with  Preputial  Sac  Unopened 14 

Fig.  9.         Penis  of   Calf   with   Sheath   forcibly  Everted  showing  un- 
opened Preputial  Sac  x  3.  15 
Fig.  9a.       Penises  of   Steers  showing  various  degrees  in   the  develop- 
ment of  the  Prepuce.  16 

Fig.  10.       Sheath,  Prepuce  and  Retracted  Penis  of  Bull 17 

Fig.  II.       Sheath,  Prepuce  and  Protruded  Penis  of  Bull 18 

Fig.  12.       Non-gravid  Uterus  of  Mare  viewed  from  Dorsal  Surface  .    .  28 

Fig.  13.       Ovaries,  Oviducts,  Uterus,  and  Cervix  of  Cow 30 

Fig.  14.       Genital  Organs  of  Bitch 31 

Fig.  15.       Cervices  of  Virgin  Heifers  opened  from  above  on  the  median 

line  exposing  the  Annular  Folds  of  the  Mucosa 34 

Fig.  16.       Above.     Transverse  Section  of  the  Cervix  between  the  An- 
nular Folds  viewed  from  the  Uterine  End 35 

Fig.  17.       Below.     Ditto  viewed  from  the  Vaginal  End 35 


842 


IUiistratio7is 


Fig.  18.       Vulva  and  Vagina  of  Cow  showing  Gartner's  Ducts  ....      37 
Fig.  19.       Vulva  and  Vagina  of    Cow  showing    Gartner's   Ducts  and 

Bartholin's  Glands 39 

Fig.  20.       Vulva  and  Vagina  of  Cow 40 

Fig.  21.       Vulva  and  Vagina  of  Cow 42 

Fig.  22.       vSection  of  Ovary  in  Cow  showing  a  Follicle,  0.6  mm.,  with 

Ovum 47 

Fig.  23.       Section  of  Ovary  of  Cow  showing  a  Follicle  of  2  mm.,  with 

Ovum 48 

Fig.  24.       Section  of  Ovary  of  Cow  with  a  nearly  ripe  Ovum  in  an  Ovi- 
sac, 5x7  mm.,  showing  Vacuoles  in  the  Cumulus  prepara- 

torj-  to  Ovulation 49 

Fig.  25.       Diagram  of  Ovary  of  Cow  showing  comparative  Sizes  of  the 

Follicles  shown  in  Figs.  22,  23,  24 50 

Fig.  26.       The  Corpus  I<uteum  of  Pregnancy 57 

Fig.  27.       Section  through  Chorionic  Placenta  of  Cow  showing  Chori- 
onic Tufts.     Enlarged  Photograph 59 

Fig.  28.       Fetal  Cotyledon  of  Cow  showing  Primary  and  Adventitious 

Placenta.     Photograph  x4 60 

Fig.  29.       Maternal  (bottom)  and  Fetal  (top)  Cotyledons  of  Cow  partly 

detached 61 

Fig.  30.       Same   as   Fig.    29,   showing   a   different   type   of   Placental 
Crypts  with  thickened,  fibrous  partitions  possibly  due  to 

prior  disease 62 

Fig.  3t.       Chorionic  Placenta  of  Ewe 63 

Fig.  32.       Left.     Uterine  Cotyledon  of  Ewe.     Right.     Median  Section 

of  Maternal  and  Fetal  Cotyledon  of  Ewe 64 

Fig.  33.       Fetal  and  Maternal  Placenta  of  Cow 65 

Fig.  34.       Same  as  Fig.  33  X  900.      (Pomayer) 66 

Fig.  35.       Necrotic  Tips  of  Fetal  Sac.     Cow 67 

Fig.  36.       Necrotic  Tips  of  Fetal  Sacs.     Swine 68 

Fig.  37.       Examination  Blank  for  Recording  Findings  in  the  Examina- 
tion of  the  Genitalia  of  Cows.     Reduced 83 

Fig.  38.       Bischoff's  Vaginal  Dilator 86 

Fig.  39.       Instruments  for  the  Examination  of  the  Genitalia  of  Cows       100 
P^iG.  40.       Median  Longitudinal  vSections  of  Cervices  of  Cows  showing 

the  Windings  of  the  Cervical  Canal      loi 

Fig.  42.       Rupture  of  Cervix  by  an  amateur  in  an  effort  to  "  open  the 
mouth  of  the   womb,"    followed   by    Chronic   Abscess  of 

Cervix 102 

Fig.  43.       Rupture  of  the  Uterus  with  Uterine  Catheter.     Cow  ....     1114 

Fig.  44.       The  Uterine  vSeal  in  Early  Pregnancy  in  Heifer 117 

P^IG.  45.       The  Uterine  Seal  of  an  Adult  Cow  in   .Vdvanctd   rngiianoy    i  iS 

Fig.  45a.     The  Uterine  Seal  in   Longitudinal  vSeclion.      Cow 119 

Fig.  46.       Lipoma  of   Mesenteric  Fat  of  Large  Intesline.     Cow  ....     137 
Fig.  47.       Arrested  Development  of  the  Genital  Tract.      lUivine  .    .    .     152 


Illustrations 


843 


Pig.  48. 
Fig.  49. 

Fig.  50. 
Fig.  51. 
Fig.  52 

Fig.  53 
Fig.  54, 
Fig.  55 
Figs.  56 
Fig.  58. 
Fig.  59. 
Fig.  59a 
Fig.  60 
Fig.  61 
Fig.  62 
Fig.  63 

Fig.  64 
Fig.  65, 
Fig.  67 
Fig.  69 
FfG.  70. 
Fig.  70a 
Fig.  70b 
Fig.  71. 


Fig.  72. 
Fig.  73. 

Fig.  74. 
Fig.  75- 
Fig.  76. 
Fig.  77. 
Fig.  78. 
Fig.  79. 

Fig.  80. 
Fig.  81. 
Fig.  82. 

Fig.  83. 
Fig.  84. 


Arrested  Development  of  Bovine  Genital  Tract  (Freeniartin)   153 
Same  as  Fig.  48  with  further  development  of  the  Muellerian 

Ducts 154 

Same  as  Figs.  48,  49      156 

Hermaphroditism.     Swine 158 

Hermaphroditism.      Horse.      Showing  Rudimentary  Penis 

below  a  commodious  Vulva ...     159 

Uterus  Unicornis.     Cow 164 

Cervix  of  a  Uterus  Unicornis 166 

Double  Cervix.     Cow 166 

57.  Persistent  Median  Walls  of  Mueller's  Ducts 168 

Large  Ventral  Hernia  preventing  Coitus 174 

Overgrown  Hoofs  interfering  with  Coitus.     Bull  ....         177 

Gunshot  Wounds  of  Testicles.     Bull 1S3 

Sutures  for  Vaginal  Hernia 187 

Rupture  of  Prepuce.     Bull 224 

Amputation  of  Penis 246 

Amputation   of   the   Penis   showing  Needle  inserted   for   a 

Suture 247 

Amputation  of  the  Penis 248 

Sarcoma  of  Genital  Tract.     Bitch 250 

Angio-Sarcom  of  Ovar)'.     Heifer 251 

Cyst-Adenoma  of  Ovary.     Sow 252 

Dermoid  Cyst.     Cryptorchid  Stallion 255 

Dermoid  C\st  of  Ovary.     Mare 256 

.     Cystic  Ovar}'  of  Mare.     Divided 256 

Large  Ovarian  Cyst  of  Pregnant  Cow  (above)  with  pair  of 
normal      Ovaries    (below)    showing    Corpus    Luteum    of 

Pregnancy 258 

Parovarian  Tumor  of  Mare,   Incarcerating  Rectum  ....     259 
View  of  Fig.  72  from  Left  Side,  the  Tumor  Exposed   by  cut- 
ting away  part  of  mesenter}" 260 

Schematic  illustration  of  Method  of  Incarceration 261 

Special  spaying  ecraseur,  55  cm.  long 264 

Colin's  scalpel 265 

Uterine  Fibroid.     Cow 275 

Uterine    Fibroid.     Mare 275 

The  Nodular  Venereal  Disease.     Vulva  and  Vulvar  End  of 

Vagina.     Cow.      ( Hutyra  and  Marek)      286 

Mild  Nodular  Venereal  Disease.     Heifer 287 

Vulva  of  Heifer  Grown  Experimentally  upon  Boiled  Milk  .     290 
Vulva  of  Heifer  Fed  in  Ordinary  Manner  as  a  Calf,  showing 

Matting  and  Staining  of  Vulvar  Tuft 291 

Bull  Calf  grown  Experimentally,  with  Clean  Preputial  Tuft  296 
Bull  Calf  of  same  age  as  Fig.  83,  grown  in  ordinar}'  Manner 
on  Raw  Milk,  showing  Matted  and  Stained  Preputial  Tuft  297 


844 


Illustrations 


Fig. 

85- 

Fig. 

86. 

Fig. 

87. 

Fig. 

88. 

Fig. 

89. 

Fig. 

90. 

Fig. 

91- 

Fig 

92. 

Fig. 

93- 

Fig. 

94. 

Fig. 

95- 

Fig 

96. 

Fig 

97- 

Fig 

98. 

Fig 

99- 

Fig 

100. 

Fig 

lOI. 

Fig 

102. 

Fig 

103. 

Fig 

104. 

Fig 

105. 

Fig 

106. 

Fig 

107. 

Fig 

108. 

Fig 

109. 

Fig 

I'IC. 

111). 
III. 

Glaus   Penis,    Prepuce,    aud  vSheath   of  Bull    showing  Mild 

Nodular  Venereal  Disease 298 

Penis  of  Bull  showing  the  Nodular  Venereal  Disease,    (^p-roni 

same  bull  as  Figs.  126,  127) 299 

Glans  Penis  of    Bull    showing  severe    (confluent)   Nodular 

Venereal  Disea.se 300 

Section  of  a  single  Nodule  from  the  Vestibule  of  the  Vagina 

showing  an  Elevation  in  the  Mucosa.      (Thorns) 301 

Section  through  4  contiguous  Nodules  which  cause  a  single, 

rather  flat  Elevation  of  the  Surface.    (Thorns) 302 

A  knob-like  Elevation  of  the  Muco.sa  due  to  several  contigu- 
ous Nodules.     (Thonis)        303 

A  section   from    Roof   of   Vagina  showing  marked   Nodule 
Formation  without  macroscopically  visible  Elevation  of  the 

Mucosa 304 

Genital  Actinomycosis.     Cow 31S 

Tuberculosis  of  Sheath  and  Prepuce  of  Bull 323 

Rupture  of  Prepuce  from  Coital  Violence 325 

Tuberculosis  of  Glans  and  Prepuce 325 

Primary  Penial  Tuberculosis      327 

Tuberculosis  of  the  Glans  and  Prepuce 330 

Lateral    View   of     Penis   of    Bull    with    Tubercular    Penial 

Adenitis 332 

Sagittal  Section  of  Fig.  98 332 

Tuberculosis  of  Ovary  and  Oviduct 335 

Serial    Horizontal    Sections  through    Ovary   and   Oviduct, 
showing  severe  Necrosis  and    Abscessation  of   Ovary  and 

Oviduct ...    336 

Tu1)erculosis  of  Oviducts  and  Cornua 33S 

Tul>erculosis  of  Ovary  aud  Oviduct 339 

Dorsal  Surface  of  Tuberculous  Oviducts,  Uterus  and  Vagina, 
showing   extensive    Pelvic   Adhesions   and    Adhesions   of 
Ovaries  in  Pavilion  of  Oviduct  and  Broad  Ligament  .    .        340 
Horizontal  section  through  Dorsal  Surface  of  Uterus,   Cor- 
nua, Ovaries,  and  Oviducts  of  Fig.  104 342 

Tuljercular  Genital  Tract  from  a  Non-reacting  Cow  in  Ad- 
vanced Tuberculosis       344 

P'xterior  of  Severely  Tubercular  Uterus  without  Pelvic  Ad- 
hesions   .    .   •     .        .    .  345 

Uterine  Tuberculosis,  Involving  chielly  the  Uterine  Glands, 

the  Peritoneum  being  free.    Longitudinal  section  of  Fig.  107  346 
Advanced  Tubo-Uterine  Tuberculosis  with  Necrosis  of  Mu- 
cosa and  Pyometra 347 

Miliary  Tuberculo.sis  of  tlu'  Superficial   Uterine  Mucosa  of  a 

\'ir.i;iii  Heifer 349 

Tul.iT.Mil<)-;is  of  the   Vaginal    Portion  of  the  Cervix  ....     351 


Ilhistrations  845 

Fig.  112.     Sagittal  Section  of  Fig.  iii 353 

Fig.  113.     Spermatozoa  from  Bull  No.  4  of  Text 3^5 

Fig.  114.  Spermatozoa  obtained  from  Bull  No.  4,  taken  25  days  after 
those  shown  in  Fig.  113,  during  which  period  the  bull  had 
complete  sexual  rest.     Spermatozoa  were  still  non-motile 

but  showed  better  staining  qualities 3^6 

Spermatozoa  from  Bull  No.  5      3^7 

Spermatozoa  from  Bull  No.  7,  with  small  heads  and   defi- 
cient nucleus 3^8 

Spermatozoa  from  Bull  No.  S 3^9 

Spermatozoa  from  Bull  No.  9 3/1 

Spermatozoa  from  Bull  No.  11 372 

Degenerative  or  Desquamative  Orchitis  in  Young  Bulls      .     376 

Degenerative  (Atrophic)   Orchitis  in  Young  Bull 377 

Purulent  Periorchitis  (Empyema  of  Scrotum)  with  Necrosis 

and  Atrophy  of  Testis 38° 

Abscessation  of  Testicle  in  Bull      381 

Chronic  Abscessation  of  Epididymis  in  Young  Bull    ....    387 

Orchitis  and  Epididymitis.     Bull 388 

Purulent  vSpermato- Vesiculitis.     Bull  (From  .same  animal  as 

Figs.  126  and  86) 39° 

Nymphomaniac  Cysts  of  Ovary 397 

Pelvis  of  Cow  showing  Ligaments 399 

Nymphomania 401 

Ovarian  Scalpel 406 

Intra- Follicular  Hemorrhage      410 

Hemorrhagic  Corpus  Luteum 413 

Cystic  Corpus  Luteum 4^5 

Cystic  Corpora  Lutea,     Cow 416 

Cystic  Corpus  Luteum 419 

Adherent  Ovary  with  very  large  Cystic  Corpus  Luteum  .    .    420 

Cystic  Degeneration  of  Corpus  Luteum 421 

Corpora  Lutea  of  Pregnancy.     For  Comparison  with  Cystic 

Corpora  Lutea 425 

Fig.  138.     Cross  section  of  Normal  Oviduct  near  the  Ampulla,  showing 

the  number  and  complexity  of  the  Mucous  Folds      .    .    .    426 

Section  of  Normal  Tube  near  the  middle 427 

Section  of  the  Normal  Oviduct  near  the  Uterine  End,  show- 
ing the  simpler  Mucous  Folds  and   the  thickness  of   the 

Muscular  Coat 427 

Highly  magnified  Section  of  Normal  Mucous  Fold  of  Oviduct  431 
Section  of   Oviduct  from  a  6-weeks-old   Calf,  showing   the 

comparative  thickness  of  the  Mucosa 431 

Fig.  143.     Normal  Section  of    the  Oviduct  showing  the  formation  of 

Cyst-like  Cavities  by  Coalescence  of  the  Folds 433 

Fig.  144.     Chronic    Catarrhal    Salpingitis,    with   a    distinct    crescent- 
shaped  inner  longitudinal  Muscular  Coat 434 


Fig. 

115. 

Fig. 

116. 

Fig. 

117. 

Fig. 

118. 

Fig. 

119. 

Fig. 

I2r. 

Fig. 

122. 

Fig. 

123. 

Fig. 

124. 

Fig. 

125- 

Fig. 

126. 

Fig. 

127. 

Fig. 

128. 

Fig. 

128a. 

Fig. 

129. 

Fig. 

129a. 

Fig. 

130. 

Fig. 

i3f- 

Fig. 

132. 

Fig. 

133- 

Fig. 

134. 

Fig. 

135- 

Fig. 

136. 

Fig. 

137. 

Fig. 

139- 

Fig. 

140. 

Fig. 

141. 

Fig. 

142. 

846  Illustrations 

Fig.  145.     Chronic  Catarrhal  vSalpiiigitis,  showing  the  Epithelium  about 

to  be  cast  off,  and  Edema  of  the  Wall  ....'. 435 

Fig.  146.     Chronic  Catarrhal  Salpingitis  with  marked   Edema  of   the 

Wall ■ 435 

Fig.  147.  Chronic  Catarrhal  vSalpingitis,  the  ]Mucous  Folds  having 
been  destroyed  and    the    Lumen  of   the  Tube   filled  with 

Debris 437 

Fig.  148.     Chronic  Catarrhal  Salpingitis  with  well  advanced  Occlusion 

of  the  Lumen  of  the  Tube 437 

Fig.  149.     Chronic  Catarrhal  Salpingitis,  with  almost  total  Occlusion  .    439 
Fig.  150.     Highly  magnified  Fold  of  the  Mucosa  in  the  acute  Stages  of 

Inflammation,  Congestion,  Exudation,  etc 439 

Fig.  151.  Highly  magnified  Fold  of  the  Mucosa  in  Chronic  Catarrhal 
Inflammation,  showing  destruction  of  the  Epithelium, 
thickening  1)y  newly  formed  Connective  Tissue,  and  Amy- 
loid or  Hyaline  Infiltration  of  the  Blood  Vessels 440 

Fig.  152.  Section  of  the  Wall  in  Hydrosalpinx,  showing  the  slightly 
changed  Epithelium,  and  the  loose,  membranous  Charac- 
ter of  the  Wall         440 

Fig.  153.  Section  of  part  of  the  Wall  in  an  old  Case  of  Tubercular  Sal- 
pingitis    441 

Fig.  .154.     Pavilionitis.     Pair  of    Adherent   Ovaries  seen  from  behind 

and  above 442 

Adherent  Ovary.     Cow 443 

Adhesion  of  Right  Oviduct  to  Ovary.      Doul)le  Left  Ovary 

with  Pregnancy 444 

Tubo-Ovarian  Abscess.     Cow 446 

Tubo-Ovarian  Abscess  with  Pelvic  Adhesions.      Horizontal 
section  through  top  of  Uterus  viewed  from  above  ....    447 

Cystic  Pavilion  of  the  Oviduct 44,s 

Cystic  Oviducts  and  Corpus  Luteuni 449 

Extreme  Bilateral  Hydro.salpinx 450 

Chronic    Endometritis  in    5-year-old,   non-pregnant    Heifer 

which  had  never  bred 454 

Fig.  163.     Complete  Pelvic  Adhesions  with  Uterus,  Coruua,  Oviilucts, 

and  Ovaries  firmly  bound  together.     Heifer 455 

Arrested  Excavation  of  Muellerian  Ducts  with  Cystic  Uterus  457 
Atresia  of  Uterine  Horn  at  Base  with  Cystic  Distension  .  .  400 
Inter-Placental  Hemorrhage  with  Desiccation  of  Fetus,  early 

stages }7o 

Inler-Placenlal  Hemorrhage  with  Desiccation  of  I'etus  .  .  471 
Complete    Desiccation    of     Fetus    following    Inter-Placenlal 

Hemorrhage      472 

Cystic  Mole 478 

Desiccated  Mole.      Cow (79 

Maceration  of  P'etiis 4S1 

Macerating  Ivnilnyo  sloughing  into  I'rinary  Bladder  ....    486 


Fig. 

155- 

Fig. 

156. 

Fig. 

157- 

Fig. 

158. 

Fig. 

159- 

Fig. 

160. 

Fig. 

161. 

Fig. 

162. 

Fig. 

164. 

Fig. 

165. 

Fig. 

166. 

Fig. 

167. 

Fig. 

168. 

V\v.. 

169. 

Fig. 

170. 

Fig. 

171. 

Fig. 

172. 

Fig. 

173- 

Fig. 

174. 

Fig. 

175- 

Fig. 

176. 

Fig. 

177. 

Fig. 

178. 

Fig. 

179- 

Fig. 

i79f 

Fig. 

180. 

Illustrations  847 

' '  The  Exudate  of  Contagious  Abortion  " 493 

Impendinsr  Abortion,  Cervicitis,  and  Endometritis  at  Cervi- 
cal End  with  Protrusion  of  Fetal  Sac  into  Vagina  ....    494 
Chart  showing  influence  of   B.  abortus  Bacterins  upon  the 

Prevalence  of  Abortion 523 

Chart  of  Agglutination  Test  on  three  Heifers  after  Inocula- 
tion with   B.    abortus,  with   failure   to   react   on    date   of 

Abortion 529 

Old  Hematoma  of  Right  Uterine  Horn 54 1 

Tesselated  Hematoma  in  Right  Uterine  Horn 542 

Septic   Metritis,   Uterus  of   Cow,  with  great   thickening  of 

Walls 555 

Large  Single-Curved  Uterine  Catheter 558 

Retained  Placenta  showing  Incarceration  and  Disintegration 
of  the  Chorionic  Tufts  and  extensive  Infiltration  with 
Leucocytes  in  the  Maternal  portion,  some  of  them  already 

broken  down.  X  310.     (After  Pomayer) 561 

Fig.  181.  Retained  Placenta.  The  Chorionic  Tufts  degenerated,  the 
maternal  Crypt  Walls  becoming  Disintegrated  and  Ne- 
crotic.    (After  Pomayer)      562 

Fig.  182.  Retained  Placenta.  Necrotic  disintegration  of  Fetal  Tufts 
and  extensive  Inflammation  with  Infiltration  in  the  Ma- 
ternal Placentae,  x  900.     (After  Pomayer) 562 

Total  Destruction  of  Uterine  Mucosa 57 1 

Pyometra  with  Granular  Mucosa 595 

Pyometra.     Median  section  through  Right  Cornu.     Cow  .    596 

Pyometra 597 

Abscessation  of  Uterus  with  Pelvic  Adhesions 602 

Abscessation  of   Uterus  with  Pelvic  Adhesions 603 

Submucous  Uterine  Abscesses " 604 

Sclerotic  Metritis  with  Pyometra 605 

Adhesion  of  Uterus  to  Bladder 607 

Pelvic  Adhesions 608 

Extensive  Pelvic  Adhesions 609 

Cystic  Degeneration  of  Uterine  Walls  with  excessive  Hydro- 

metra 612 

Vaginal  Ends  of  Cervices 615 

Uterine  Syringe  with  Conical  and  Curved  Nozzles 619 

Cervical  Abscesses 623 

Cervical  Abscess  from  "Opening  the  Womb  ",  ventral  side  624 

Laceration  of  Lips  of  Cervix  Uteri 627 

Circular  Amputation  of  Cervix  Uteri 632 

Special  Instruments  for  Trachelectomy 633 

Circular  Amputation  of  Cervix  Uteri 634 

Circular  Amputation  of  Cervix  Uteri 636 

Circular  Amputation  of  Cervix  Uteri    .    .  637 


Fig. 

183. 

Fig. 

184. 

Fig. 

185. 

Fig. 

186. 

Fig. 

187. 

Fig. 

iS7a. 

Fig. 

188. 

Fig. 

189. 

Fig. 

190. 

Fig. 

191. 

Fig. 

192. 

Fig. 

193- 

Fig. 

194. 

Fig. 

196. 

Fig. 

197. 

Fig. 

198. 

Fig. 

199. 

Fig. 

200. 

Fig. 

20oa. 

Fig. 

201. 

Fig. 

202. 

Fig. 

203. 

848  Illustrations 

Fig.  204.     Circular  Amputation  of  Cervix  Uteri       638 

Fig.  205.     Costal  Pleura  of  Abort  at  Full  Term,  showinj^  the  Petechiae 
and  Hemorrhages  commonly  seen  in  Abortion,  Calf  Sepsis, 

and  Dysentery 664 

Fig.  206.     Abscess  of  vSpiual  Canal  in  Calf,  from  Pyemia 664 

Fig.  207.     Tlie  Relationship  between  Calf  Dysentery  and  Pneumonia 

and  the  Prevalence  of  Abortion  in  First  Prej^nancv  ....    667 

Fig.  208.     Chart  of  Calf  No.  70,  fed  upon  Autoclaved  Milk 677 

Fig.  209.     Continuation  of  Fig.  208 67S 

Fig.  210.     Chart  of  Calf  No.  71,  fed  upon  Autoclaved  Milk 679 

Fig.  211.     Continuation  of  Fig.  210 6S0 

Fig.  212.     Re-Examination   Records  for  the  Genital   Organs  of  Cows 

( See  also  Fig.  37 ) "    .    .  .698 

Fig.  213.     Estrum   and    Service   Index   Card    for   keeping    Breeding 

Records 699 

Fig.  214.     Retained  Placenta  in  Ewe 731 

Fig.  215.     Tuljerculosis  of  Testis.     Boar 737 

Fig.  216.     Ovaries  of  vSow 741 

Fig.  217.     Cystic  Ovaries.     Sow        742 

Fig.  218.     Bilateral  Hydrosalpinx  developed  during  Pregnancy.     Sow  743 

Fig.  219.     Desiccated  "  Mole  "  in  Swine  Uterus 744 

Fig.  220.     Necrotic  Swine  Embryo  with  Necrotic  Fetal  Sac 745 

Fig.  221.     Necrotic  Swine  Embryo 747 

Fig.  222.  Necrotic  and  Healthy  Swine  Embryos  from  same  Uterus  .  747 
Fig.  223.     Stallion  in    Early  Stages  of   Dourine,  showing    Edematous 

Prepuce.      (]5aldrey) 755 

Fig.  224.     Dourine,  showing  Penial  Paralysis.     (Baldrey) 756 

Fig.  225.     Advanced  Dourine  in  Mare  with  extreme   Emaciation  and 
showing  Depigmentation  of  Vulvar    Ups.       (Hutvra  and 

Marek) 75S 

Fig.  226.     Orchitis  and  Epididymitis.     Stallion 783 

Fig.  227.     Orchitis  and  Epididymitis 784 

Fig.  228.     F;nlarged  Seminal  Vesicles.     Gelding 7S6 

Fig.  229.     Cy.stic  Ovary,  Reduced.     Nymphomania 791 

V\c,.  230.      Fetal  Placenta  of  Abortion 795 

Fig.  231.     Pyometra S08 

Fig.  232.     Ab.scess  of  Umbilic  Vein  and  Artery.     Foal 817 

Fig.s.  233  &.  234.   Arthritis  of  Carpus 818 

Fig.  235.      Pyemia  of  New-born  819 

Fig.  236.      Rujjture  of  F:xlensor  Tendons  at  Cari)us  and   I'loating  Dis- 
location of  Patella    .    .     S2S 

Fig.  237.     Rupture  of  the  Exten.sor  Pedis  Longus  Muscle  in  New-born 

Foal  ; 826 

Fu;.  238.  Infectious  Venereal  Granuloma  of  Dog.  (C.A.White).  .  828 
Fig.  239.  Infectious  Venereal  Granuloma  of  Bitch.  (C.A.White)  .  829 
Fig.  240.      Infectious  Venereal  Granuloma  of  Bitch.     (C.  A.  White)  .    .     830 

iMC.  241.     .Normal  and  Cystic  Ovaries  of  Bitch 833 

I'lc.  242.     Gravid  rt(.-rus  of  Bitch  in  Situ 835 

I'iG.  243.      Pyometra.      Cat        S-J7 


ALPHABETICAL  INDEX 


Aberrations  and   Arrests  in   Genital 
Development,  151 
Asexual,  151 
Bisexual,  151 

in    the     Development     of     the 
Penis,  16.^ 
Abortion,  487 

"  Accidental,"  495 
Artificial,  146 
Bacillus  of  Bang,  499 
Bacterins,  527 

"  Contagious,"      (See    General 
Infections  of  the  Genital  Or- 
gans of  Cattle)  356 
Control  of,  519 
"  I'ood,"  496 
History  of,  488 
"  Infectious  "  487 
in  Carnivora  831 
in  Cattle,  356 
in  Mares,  778 
in  Sheep  and  Goats,  717 
in  Swine,  738 
Serum,  526 

Symptoms  and  Diagnosis  of,  517 
The  Biology  of,  498 
The  Nature  of,  511 
"  Traumatic,"  495 
Vaccines,  527 
Abscess  of  Ovary,  424 
Uterine,  601 
Uterine,  Mare,  806 
Abscessation  of  Uterine  Submucosa, 
604 
of  Gartner's  Ducts,  649 
of  the  Uterus  with  Fetal  Reten- 
tion, 484 
Abscesses,  Pyemic,  Mare,  809 
"Accidental  Abortion,"  495 
Actinomycosis,  Genital,  of  Cattle,  3 1 7 
Addition  of  Breeding  Animals  to  es- 
tablished Herds,  688 
Adhesions,  Cervical,  641 

Pelvic,   606 
Amputation  of  the  Cervix,  Circular, 

631 
of  Penis,  245 

Anatomy  and  Physiology  of  Genital 

Organs,  i 
Apical    Endometritis  with  Necrosis 

of  the  Apices  of  the  Fetal  Sac, 

462 


Arrests  and  Aberrations  in  the  De- 
velopment of  the  Testes,  160 
in   Genital  Development,   151 
in    Functional    Development  of 
Scrotal  Testes,  ( Fetal  Testes, ) 
161 
in  the  Development  of  the  Male 
Genitalia,  160 
Arthritis  in  Foal,  815 

Pyemic,  in  Cow,  609 
Pyemic,  in  Calf,  651 
Artificial  Abortion,  146 
Impregnation,  143 
Induction  of  Estrum,  140 
Insemination,  143 
Interferences    with     Reproduc- 
tion, 140 
Asexual  Aberrations,  151 
Assembling  of  Herds,  688 
Atretic  Follicles,  395 

in  Mare,  788 
Bacterins,  Abortion,  527 
Bacterium  Abortus  of  Bang,  499 
Balanitis,  295,  393 
Bang,  Bacterium  Abortus  of,  499 
Bartholin's  Glands,  44 
Benign  Tumors  of  the  Female  Geni- 
talia, 257 
of  the  Genital  Organs,  253 
of  the  Male  Genitalia,  253 
of  the  Uterus,  274 
Biology  of  Abortion,  498 
Bisexual  Aberrations,  151 
Bites  Causing   Contusions  of    Neck 

and  Withers,  219 
Bladder.    Urinary,    Alleged  Rupture 

of  the,  by  the  Penis,  217 
Breeding  Animals,  the  Addition  of, 

to  Established  Herds,  688 
"  Broken  Penis,"  219 
Bulls,  Epididymitis  of,  385 

Nodular  Venereal  Disease  in,  295 

Orchitis  of,  375 

The   General    Infections  of   the 

Genital  Organs  of,  358 
Spermatozoa  of,  362 
Bursattee  of  the  Penis  and   Prepuce, 

775 
Calf  Dysentery,  651 

Pneumonia,  651 

Scours,  651 

Septicemia,  651 
Calluses,  Pelvic,  190 


54 


850 


Alphabetical  hid  ex 


Calves,  Degenerative  Orchitis  of,  375 
Epidid^-mal  Abscesses  of,  385 
The   Cougenital    Infections   of, 
651 

Carnivora,  the  General  Genital  In- 
fections of,  831 
The  Genital  Infections  of,  828 

Cat,  the  General  Genital  Infectious 
of,  831 
The  Genital  Infections  of,  828 

Cattle  Breeding,  Equipment  for,  694 
Nodular  Venereal  Disease  of,  283 
The    General    Infections  of  the 

Genital  Organs  of,  356 
Genital  Infections  of,  278 
Specific  Venereal  Diseases  of,  278 
Vesicular  Venereal  Disease  of ,  278 

Cellulitis,  Contagious,  of  Horse,  770 

Central   or   Embedded   Corpus   Lu- 
teum,  422 

Cervical  Adhesions,  641 

Canal,  Examination  of  the,  99 
Endometritis,  465 
Infections,  614 
Prolapse,  642 

Cervicitis,  614 

Fetal  Retention  from,  641 

Cervicitis,  Mare,  810 

Cervix,  The,  33 

Circular  Amputation  of  the,  631 
Double,  165 
Lacerations  of,  229 
Retention  Cysts  of  the,  642 
Tuberculosis  of  the,  350 

Chronic  Endometritis,  Mare,  805 

Circular  Amputation  of  the  Cervix, 

Clinical  Examination  of  the  t'emale 
Genital  Organs,  79 
Examination  of  the  Genital  Or- 
gans, 73 
Examination   of    Male    Genital 
Organs,  73 
Clitoris,  The,  44 
"  Closure  of  the  Womb,"  640 
Coital  Exanthem,  766 

Injuries,  205 
Congenital    Defects   of    the    I'emale 
Genitalia,  163 
Infections  of  Calves,  651 
"Contagious  Abortion,"    (See  Gen- 
eral Infections  of  the  Genital 
Organs  of  Cattle),  356 
Contagions  Cellulitis  of  Ilorse,  7711 
Control  of  Abortion,  519 

of   Genital  Infections  in    Herds, 
697 
Contusions    of    Neck     and     Willurs 
frijiii  bites,  21Q 


Copulation,  53 

False,  210 
Corpora  Nigra,  425 
Corpus  Luteum,  Central  or  Embed- 
ded, 422 

Cystic  Degeneration  of,  413 

Hemorrhagic,  412 

Hypertrophy  of  the,  418 

of  Estrum,  the,  52 

of  Fetal  Retention,  422 

of  Pyometra,  422 

Persistent,  421 

of  Pregnancy,  56 
Cotyledon  of  Cow,  60 

of  Ewe,  64 
Cotyledonitis,  560 

Cows,  General  Infections  of  the  Gen- 
ital Organs  of,  394 

Ovariotomy   in,   bv   the    Flank, 
273 

Vaginal  Ovariotomy  in,  270 

Cowper's  Glands,  10 
Examination  of,   76 
Diseases  of,  (Bull),  393 
Cryptorchidy,  i6a 
Cystic  Mole,  477 

Degeneration  of  the  Corpus  I,n- 

teuni,  413 
Degeneration     of     the     Ovarv, 

Mare,  788 
Degeneration  of  the  Ovisacs,  395 
Degeneration     of     the    Uterine 
Walls,  6[i 
Cystitis,  Mare,  812 
Cysts  of  Gartner's  Ducts,  649 
in  the  INIesosalpinx,  452 
Par-Ovarian,  425 
Retention,  of  the  Cervix,  642 
Dairying,  I^quijiment  for,  694 
Death  and  :\Iaceration    of  the   Em- 
bryo, 480 
of  the  Embryo  with  Persistence 

of  Embryonic  Sac,  477 

of  the  Fertilized  Ovum,  476 

Degeneration,  Cvstic,  of  the  Ovisacs, 

395  . 
Degenerative  Orciiitis  of  Calves,  375 
Desiccation  of  Fetus,  470 
Diagnosis  of  lustrum,  1 1 1 
of  Pregnancy,  31 1 
of  Twin  Pregnancy,  127 
Diarrhea,  Calf  (see  Dysentery)  651 
Diarrhea,  I"'oaI,  (see  Dysentery)  815 
Diffuse  Endometritis  of  Pregnancv, 
464 


Alphabetical  hide: 


851 


Diseases  and  Defects,  Miscellaneous, 

Interfering  with  Fertility,   172 

of   Feet  and  Limbs  (Interfering 

with  Coitus),  177 
Systemic,  Interfering  with    Re- 
production, 192 
Dog,  the  General  Genital  Infections, 
of,  831 
The  Genital  Infections  of,  828 
Venereal  Tumors  of  the,  828 
Double  Cervix,  165 
Uterus,  165 
Vagina,  167 
Douching  the  Uterus  for  Diagnosis, 

99 
Dourine,  752 
Dropsy  of  Joints,  Foal,  824 

of  the  Pavilion  of  the  Oviduct, 
448 
Ducts  of  Gartner,  39 

of  Mueller,  22 
Duration  of  Pregnancy,  the  Diagno- 
sis of,  129 
Dysenterv,  Calf,  651 

FoaC  Srs 
Embryo,  Infections  of  the,  476 

Infections  of  the,  in  Mare,  793 

Maceration  of  the,  480 
Embryos,  Necrotic,  of  Swine,  73S 
Embryonic  Sac,  Persistence  of,  after 

Death  of  Embryo,  477 
Emphysema  of  the  Fetus,  487 
Endometritis,  Apical,  462 

Cervical,  465 

Chronic,  in  Mare,  805 

in    Heifers   and    Heifer   Calves, 

453 
Post-Puerperal,  589 
of  Pregnancy,  Diffuse,  464 
Puerpt-ral,  546 

with      Retained       Fetal     Mem- 
branes, Mare,  799 
Epididymal  Abscesses  of  Calves,  386 
Epididymis,  The,  6 

The  Examination  of,  75 
Epididymitis  of  Stallions,  782 
of  Adult  Bulls,  3S8 
of  Bulls,  385 
"  Epizootic  Abortion  "    (see  General 
Infections  of  the  Genital  Or- 
gans of  Cattle),  356 
Equipment  for  Cattle  Breeding  and 

Dairying,  694 
Eruptive   Venereal   Disease    of   the 

Horse,  766 
Estruni,  47 


Estrum,  The  Artificial  Induction  of, 

140 
The  Corpus  Luteuni  of,  52 
The  Diagnosis  of,  iii 
Eversiou   of    Vagina    (see    Cervical 

Prolapse)  642 
Examination  of  Cervical  Canal,  99 
Excessive  Sexual  Use,  200 
Excision  of  the  Prolapsed  Endocer- 

vical  fold,  630 
Fallopian  Tube  (see  under  Oviduct) 

I  ^5 

Fimbriated  End  of,  (see  under 
Pavilion  of  the  Oviduct)    25 
False  Copulation,  210 
Feet  and  Limbs,  Diseases  of   (Inter- 
fering with  Coitus),  177 
Female  Generative  Organs,  The,  18 
Genital  Organs,  the  Clinical  Ex- 
amination of,  79 
I  Genitalia,     Congenital     Defects 

of,  163 
Genitalia,    Tuberculosis   of  the, 

334 
Fertility,  Miscellaneous  Defects  and 
Diseases  Interfering  with,  172 
Fertilization,  55 
Fertilized  Ovum,    the   Migration  of 

tbe.  55 
Fetal  Desiccation,  470 
Emphysema,  487 
Membranes,  The  58 
Membranes,  Retained,  Cow,  560 
I  Membranes,      Retained,     Mare, 

799 
Retention,   Corpus   Luteum   of, 

422 
Retention  from  Cervicitis,  641 
Sac,   Necrosis  of  the  Apices  of, 
462 
Fetus,  Infections  of  the,  476 

Maceration  of  the,  480 
Fistula,  Recto-vaginal,  229 
Foal,  Septicemia  of  the,  814 

The  Intra-Uterine  Infections  of, 
i  814 

"  Food  Abortion,"  496 
Follicular  Crater,    Hemorrhage  into 

the,  411 
Follicles,  Atretic,  395 
Fractures  and  Kicks  (During  Coitus) 

206 
"  Freemartins,"  151 
Gangrene,    Uterine,    of   Pregnancy, 
467 
Vaginal,  647 
Gartner's  Ducts,  39 

Cysts  and  Abscesses  of,  649 


852 


Alphabetical  Inde. 


General  (ienital  Infectious  of  Cariii- 
vora,  831 

Infectious  of  the  Genital  Organs 
of  Bulls,  358 

Infections  of  the  Genital  Organs 
of  Cattle,  "Contagious  Abor- 
tion," 356 

Infections  of  the  Genital  Organs 
of  Cows,  394 

Genital  Infections  of  Stallions, 
782 

Infections  of  the  Genitalia  of 
Horses,  778 

Infectious  of  the  Genitalia  of 
Mares,  78S 

Infections  of  the  Genitalia  of 
Sheep  and  Goats,  717 

Infectious   of   the   Genitalia    of 
Swine,  738 
Generative  Organs,  The  Female,  iS 
Genital  Actinomycosis  of  Cattle,  317 

Development,  Arrests  and  Aber- 
rations in,  151 

Horse  Pox,  766 

Infectious  of  Carnivora,  the,  828 

Genital  Infections  of  Cattle,  278  ;   as 

related  to  Human  Health,  709  ; 

as  an  Economic  Problem,  708 

of  Horses,  752 

of  Sheep  and  Goats,  713 

of  Stallions,  7S2 

of  Swine,  736 

The  General,  of  Carnivora,  831 
Genital  Organs,  Anatomy  and  Phy- 
siology of,  I 

Benign  Tumors  of  the,   253 

Infectious  of  the,  278 

of  Bulls,  the  General  Infectious 
of.  358 

of  Cattle,  the  General  Infectious 
of,  356 

of  Cows,  the  General  Infections 

o*"'  394. 

The  Clinical  Examination  of,  73 

The  Clinical  Examination  of. 
Female,  79 

The  Clinical  Ivxaminatiou  of, 
Male,  73 

Tumors  of  the,  239 

Tuberculosis  of,  in  Cattle,  319 

Tuberculosis  of,  in  Swine,  736 
Genitalia,    Female,    Congenital    De- 
fects of,  163 

Male,  Anatomy  of,  1 

Male,  Arrests  in  the  Deviloj)- 
uient  of,  160 

Malignant  New-Growths  of  tin- 
I'emale,  25(j 

Rectal  Pal])alion  of,  89 

Tile  Physiology  of  the,  44 


Germinal  vSpot,  45 

(rlands,  Bartholin's,  44 

Glaus   Penis,    Tuberculosis   of   the. 

Bull,  326 
Goats,  Abortion  in,  717 

General  Infections  of  the  Geni- 
talia of,  717 
Genital  Infections  of,   713 
Retained   Fetal    Membranes  in. 

Graafian  Follicle  (see  under  Ovisac) 

18 
Gravid  Uterus,  Infectious  of  the,  462 
Health,  Human,  and  the  Genital  In- 
fections of  Cattle,  709 
Heifer   Calves,    lutra-Uterine  Infec- 
tion in,  453 
Heifers,    Intra-Uterine  Infection   in, 
453 
Pyometra  in,  45S 
Hematoma,  Uterine,  539 
Hemorrhage,  Inter-Placental,  470 
into  the  Follicular  Crater,  411 
Intra-Follicular,  409 
Placental,   70 
Urethral,  in  Stallions,  218 
Uterine,  539 

Vaginal,  following  Coitus,  218 
Hemorrhagic  Corpus  Luteum,  412 
Herds,    The  Addition    of    Breeding 
Animals  to,  688 
The  Assembling  of,  688 
The   Control   of    Genital   Infec- 
tious in,  697 
Hermaphroditism,  157 
Hernia,  Strangulated,  225 

Umbilic,  Interfering  with  Fertili- 
ty,  172 
Vaginal,  185 

Ventral    (Interfering    with   I'er- 
tility),  174 
Horizontal    Vulva  (Interfering  with 

Coitus),  174 
Horse  Pox,  Genital,  766 
Horses,  the  General  Infections  of  the 
Genitalia  of,  778 
The  Genital  Infectious  of,  752 
Hydrometra,  611 
Hydrosalpinx,  (Cow)  44S 
Hymen,  The,  41 

Persistent,  169 
Hvpertrophv  of  the  Corpus  I.uteuui, 

4>'^ 
I(lU'iu-ss  and  ( )\erfi'e(liug,   U)6 
Iiu])reguati(>u,  Arlilicial,   143 
ludut.iUd    I';])i(li(lviu;d  Abscesses  of 
Calves,  3Sb  " 


Alphabetical  Index 


853 


Infections,  Cervical,  614 

General,  of  the   Genital  Organs 

of  Bulls,  358 
General,  of  the  Genital  Organs 

of  Cattle,  356 
General,  of  the   Genital  Organs 

of  Cows,  394 
Non-Venereal,      Invading      the 

Genitalia  of  Cattle,  317 
of  Calves,  the  Congenital,  651 
of  Foals,  the  Intra-Uterine,  814 
of  the  Embryo  in  Mare,  793 
of  the  Genital  Organs,  278 
of  the  Gravid  Uterus,  462 
of  the  Gravid  Uterus    in  Mare, 

793 
of     the    Ovum,      Embryo     and 

Fetus,  476 
of  the  Puerperal   Uterus,  INIare, 

799 
of  the  Uterus,     Post-Puerperal, 

Mare,  805 
of  the  Vagina,  645 
of  the  Vulva,  650 
Tubal  (Cow),  426 
Uterine  (Cow),  453 
"Infectious  Abortion"   (see  General 
Infections  of  the  Genital  Organs 
of  Cattle),  356 
Vaginitis,  283 
Injuries,  Coital,  205 
Parturient,   228 
Penial,  219 

to  Genital  and  Other  Organs  by 
Sexually  Psycopathic  Men,  231 
Insemination,  Artificial,  143 
Intra-FoUicular  Hemorrhage,  409 
Inter-Placental     Hemorrhage     with 

Fetal  Desiccation,  470 
Intra-Uterine  Infection  in  Foals,  814 
Intra-Uterine    Infection    in    Heifers 

and  Heifer  Calves,  453 
Inversion   of   Vagina   (see    Cervical 

Prolapse)  642 
Joint-Ul,  651 

in  Foal  (see  Arthritis),  815 
Kicks  and  Fractures  (during  Coitus). 

206 
Laceration  and  Rupture  of  the  Va- 
gina, 214 
of  the  Cervix,  229 
of  the  Perineum,  228 
Laminitis,  Puerperal,  585 
Puerperal,  Mare,  799 
Lead    Poisoning,     (Interfering  with 

Coitus,)  179 
Lip-and-Leg  IHceration  in  vSheepand 
Goats,  713 


Maceration  of  the  Enibrvo  or  Fetus, 

4S0 
Male   Genital   Organs,   the   Clinical 

Examination  of,  73 
Male  Genitalia,  i 

Arrests  in  the  Development  of, 

160 
Malignant  tumors  of,  239 
Malignant  New-growths   of  the  Fe- 
male Genitalia,  250 
Tumors,  239 

Tumors  of  the  Male  Genitalia,  239 
Mare,    Cystic    Degeneration  of  the 
Ovary  of,  788 
Diseases  of  the  Ovaries  of,  788 
Nymphomania  in,  788 
Ovariotomy  in,  by  the  Flank,  273 
Pyometra  in,  807 
Vaginal  Ovariotomy  in,  263 
Mares,  Abortion  in,  778' 

General  Infections  of  the  Geni- 
talia of,  788 
Masturbation,  203 
Meconium,    Retention    of    the,     in 

Foal,  814 
Membranes,  The  Fetal,  58 
Meningitis,  Puerperal,  585 
INIenstruation,  51 
Mesosalpinx,  Cysts  in  the,  452 
Metritis,  Mare,  803 
Sclerotic,  605 
Septic,  554 

Septic   of  Pregnancy,  467 
Metro- Peritonitis,  Mare,  803 
Migration  of  Fertilized  Ovum,  55 
Miscellaneous  Defects  and  Diseases 

Interfering  with  Fertility,  172 
Mole,  Cystic,  477 
Muellerian  Ducts,  the,  22 
Mummification  of  Fetus,  470 
Mummified  Fetus,  470 
Nature  of  Abortion,  The,  511 
Navel-Ill,  Foal,  (see  Dysentery ),  815 
Neck,  Contusions  of,  from  Bites,  219 
Necrosis  of  the  Apices  of  the  Fetal 

Sac,  462 
Necrotic  Embryos  of  Swine,  738 
Tips  of  Fetal  Sac,  65 
Venereal   Disease  in  Sheep,  713 
Neuters,  151 

New-Growths  of  the  Female  Geni- 
talia, Malignant,  250 
Nodular  Venereal  Disease  in   Bulls, 

295 
in  Cattle,  283 
in  Swine,  736 
in  Sheep  and  Goats,  713 


854 


Alphabetical  Iiidex 


Non-Venereal    Infections    Invading 

the  Genitalia  of  Cattle,  317 
Nvmplioniania,  in  Cows,  395 

in  Mares,  788 
Obesit}-  (Interfering  with  ReprocUic- 

tion),  194 
Onanism,  203 
Oophorectoni}',  Vaginal,  in  the  Mare, 

263 
Orchitis  and    Epididymitis  of  Stal- 
lions, 782 
Degenerative,  of  Calves,  375 
in  Adult  Bulls,  379 
of  Bulls,  375 
Traumatic,  iSi 
Ova,  Permanent,  45 
Ova,  Primitive,  45 
Ovarian  Tuberculosis,  334 
Ovaries,  Diseases  of  the,  394 

of  the  Mare,  Diseases  of,  788 
Ovariotomy  in  the  Cow  and  Mare  by 
the  Flank,  273 
Vaginal,  in  the  Cow,  270 
Vaginal,  in  the  Mare,  263 
Ovaritis.  394 
Ovary,  The,    18 

Abscess  of,  424 

Cystic   Degeneration   of.   Mare, 

788 
Rectal,  Palpation  of,  95 
Tuberculosis  of,  334 
Overfeeding  and  Idleness,  196 
Overwork  ( Interfering  with  Repro- 
duction), 192 
Oviduct,  Rectal  Palpation  of,  95 
Oviducts,  The,  25 

Ovisacs,  Cystic  Degeneration  of,  395 
Ovulation,  49 

Ovum,   Fertilized,  Death  of  the,  476 
Infections  of  the,  476 
The  Migration  of  the  Fertilized, 
55 
Palpation  of  Genitalia,  Rectal,  89 
Paralysis  and  Plumbism  (Interfering 

with  Coitus),  179 
Parametritis,  606 
I'ar-Ovarian  Cysts,  425 
Parturient  Injuries,  228 
Pavilion  f)f  the  Oviduct,  Dropsv  of, 

448 
Pelvic  Adhesions,  606 

Tumors  and  Calluses,    190 
Penial  Injuries,  219 

l.vmph  (Uands,  Tu1)erculosis  of, 

'Hull,  333 
.Sheath,  Tuberculosis  of   the,   in 

Bulls,  32c) 
Tul)C'rcul()sis  of  tlie  I'.ull,  32.1 


Penis,  The,  14 

Aberrations  in  the  Development 
of,  163 

Amputation  of  the,  245 

Bursattee  of.  775 

Tuberculosis  of,  324 
Perineum,  Lacerations  of  the,  228 
Peri- Vaginal  Phlegmon,  648 
Permanent  Ova,  45 
Persistent  Corpus  Luteum,  421 

Hymen,  169 
Persistence     of     Median    Walls     of 
Muellerian   Ducts  in  Vagina, 
167 
Phlegmon,  Peri-Vaginal,  64S 
Physiology  of  the  Genitalia,  The,  44 
Pink  E^ye,  770 
Placenta,  Retained,  560 
Placental  Hemorrhage,  70 
Placentitis,  560 

Mare,  799 

of  Pregnancy,  469 
Pneumonia,  Calf.  651 
Post-Puerperal     Infectious     of     the 
Uterus,  586 

Infections  of  the  Uterus,  I\Iare, 
805 
Pregnancy,  Diffuse  Endometritis  of, 
464" 

Placentitis  of.  469 

The  Corpus  Luteum  of,  56 

The  Diagnosis  of.   1 13 

The   Diagnosis  of  the  Duration 
of,  129 

Tubal,  185 

Twin,  15 

The  Diagnosis  of  Twin,  127 
Prepuce,  Bursattee  of,  775 

Ru]iture  of  the,  223 
Preputial  Tuberculosis  in  Bulls,   330 
Primitive  Ova,  45 
Prolapse,  Cervical,  642 

of    Vagina     (see    Cervical     Pro- 
lapse) 642 
Prostate  Gland,  10 

Diseases  of,  (Bull)  393 

Examination  of,  76 
Puerperal  Diseases  of  the  Uterus,  538 

luulometrilis,  546 

I,amiiiitis,  Cow,  585 

Laminitis,  Mare,  794 

IVIeuingitis,  585 

Tetanus,  584 

Uterus,  Infections  of  llu-,  Mare, 

799 
Pyemia,  Foal,  815 

Post-Pueiperal,  609 


Alphabetical  Index 


855 


Pyemic  Abscesses,  609 
in  Mare,  809 
Arthritis,  65  r 
Pyometra,  Corpus  Luteum  of,  422 
iu  Heifers,  458 
Mare,  807 

of  Fetal  Decomposition,  4S0 
Post-Puerperal,  594 
Pyosalpiux  (Cow),  445 
Rabbits,  Venereal  Disease  of,  S38 
Rectal  Palpation  of  Genitalia,  89 
Recto- Vaginal  Fistula,  229 
Rectum,     Injuries    to,     from    False 

Copulation,  210 
Reproduction,      Artificial     Interfer- 
ences with,   140 
Retained  Fetal  Membranes,  Cow,  560 
Mare,  79q 

in  Sheep  and  Goats,  717 
Placenta,  560 
Retention  Cysts  of  the  Cervix,  642 
Retention   of  the  Meconium,    Foal, 
814 
of    Menstrual  Debris  from  Cer- 
vicitis, 640 
Rupture  of  the  Prepuce,  223 
of  Tendons.  Foal,  S24 
of   the  Uterus    by  the  Penis  of 

the  Bull,  216 
of  the  Vagina,  214 
Sadism  and  Sodomy,  231 
Salpingitis  (Cow),  428 
Sand,  Uterine,  70 
Sclerotic  Metritis,  605 
Scours,  Calf,  651 
White,  651 

in  F'oal  (see  Dysentery),  815 
Seal,  Uterine,  117 
Semen,  p;xamination  of,  77 
Seminal  Vesicles,  10 

Diseases  of.  Horse,  785 
Examination  of  the,  76 
Inflammation  of  (Bull),  389 
Semino- Vesiculitis,  Horse,  785 

Bull,  389 
Septic  Metritis,  554 

of  Pregnancy, 467 
Septicemia  of  Calf,  651 

of  Foal,  814 
Serum,  Abortion,  526 
Sexual  Use,  Excessive,  200 
Sheath,  The,  15 
Sheep,  Abortion  in,  717 

Retained    Fetal    Membranes  in. 

717 
The    General    Infections   of  the 

Genitalia  of,  717 
The  Genital  Infections  of,  713 
Synovial  Distensions,  Foal,  S24 
Sodomv  and  Sadism,  231 


Specific  Venereal  Diseases  of  Cattle, 
278 
of  Dog,  828 
of  Horses,  752 
Spermatozoa  of  Bull,  362 

Examination  of  the,  77 
Spermato-Cystitis,  (Bull),  389 
Stallions,  Epididymitis  of,  782 
Genital  Infections  of,  782 
Orchitis  of,  782 
Starvation  (Interfering  with  Repro- 
duction), (93 
Strangulated  Hernia,  225 
Strictures  of  Vagina  and  Vulva,    175 
Swine,  Abortion  in,  738 

General  Infections  of  the  Geni- 
talia of,  738 
Genital  Infections  of,  736 
Necrotic  Embryos  in,  738 
Systematic   Control   of   Genital   In- 
fections, The,  697 
Systemic   Diseases  Interfering  with 

Reproduction,  192 
Tendons,  Rupture  of  the.  Foal,  824 
Tetanus,  Puerperal,  584 
Testes,    Arrests  and   Aberrations  in 
the  Development  of ,  160 
Scrotal,    Arrest    in    Functional 
Development  of,  16  [ 
Testicle,  Torsion  of  the,  180 
Tesicles,  and  their  Excretory  Ducts,  i 

The  Examination  of,  74 
Testis,    Abnormal    Position    of,    in 

Scrotum,  16  r 
Torsion  of  Testicles,  180 

of  Uterus,  189 
Trachelectomy,  630 
Trachelorrhaphy,  626 
Tracheoplasty,  625 
"  Traumatic  Abortion,"  495 

Orchitis,  181 
Tubal  Infections  (Cow),  426 
Pregnancy,   185 
Tuberculosis,  337 
Tuberculosis,  Genital,  in  Swine,  736 
of  Cattle,  319 
of  the  Cervix,  350 
of  the  Female  Genitalia,  334 
of  the  Glans  Penis,  Bull,  326 
of   the    Penial    Lymph  Glands, 

Bull,  333 
of  the  Penial  Sheath  m  the  Bull, 

329 
Ovarian,  334 
Penial,  of  the  Bull,  324 
Preputial,  in  Bulls,  330 
Tubal,  337 
Uterine,  341 
Vaginal,  352 
Vulvar,  352 


856 


Alphabetical  Index 


Tumors,    Benign,  of  the  Genital  Or- 
gans, 253 
Malignant,    of   the    Genital    Or- 
gans, 239 
Pelvic,   190 

Venereal,  of  the  Dog,  828 
Twin   Pregnancy,  The  Diagnosis  of, 

127 
Umbilic    Hernia     Interfering    \vilh 

Fertility,  172 
Urachus,   Re-Opening  of  the,   Foal, 

820 
Urethral    Hemorrhage   in   Stallions, 

218 
Urinary    Bladder,    Alleged    Rupture 

of  the,  by  the  Penis,  217 
Uterine  Abscess,  601 

Abscesses,  Mare,  806 
Arteries,  The,  in  Pregnancy,  121 
Gangrene  of  Pregnancy,  467 
Hematoma,  539 
Hemorrhage,  Puerperal,  539 
Infections  (Cow),  453 
Infections  and  Infections  of  the 

Embryo,  Mare,  793 
Sand,  70 
Seal,  The,  117 
Uterine  Submucosa,  Abscessation  of, 
604 
Tuberculosis,  341 
Walls,   Cystic  Degeneration  of, 
61 1 
Utero-Chorionic  Space,  Tlie,  69 
Uterus,  The,  26 

Abscessation   of  the,   with  Fetal 

Retention,  484 
Benign  Tumors  of,  274 
Double,  165 

Douching  the,  for  Diagnosis,   99 
Gravid,  Infections  of  tlie,  462 
One-Horned,  165 
Post-Puerperal,     Infections     of 
the,  586 
Infections  of  the,  Mare,  805 
Puerperal,  Diseases  of  the,  538 

Infections  of  the,  in  Mare,  799 
Rectal  Palpation  of,  93 

Rupture  of  the,  by  the  Penis  of 
the  Bull,  216 

Torsion  of  tlie,  189 
Unicornis,  165 
Vaccines,  Aljorlion,  527 


Vagina,  The,  36 
Double,  167 
Examination  of  the,  84 
Infections  of  the,  645 
Laceration  and  Rupture  of  the, 

214 
Persistence  of  Median  Walls  of 

:Muellerian  Ducts  in,  167 
Prolapse  of   (see    Cervical    Pro- 
lapse), 642 
Strictures  of,  ]  75 
Vaginal  Gangrene,  647 

Hemorrhage    following    Coitus, 

218 
Hernia,  185 
Ovariotomy  in  the  Cow,  270 

in  the  Mare,  263 
Prolapse  (see  Cervical  Prolapse\ 

642 
Tu])erculosis,  352 
Vaginitis,  645 

Infectious,  283 
Mare,  81 1 
Venereal  Disease 

in  Sheep,  Necrotic,  713 
Nodular,  in  Bulls,  295 
in  Cattle,  283 
in  Sheep  and  Goats,  713 
in  Swine,  736 
of  Rabbits,  838 
Specific,  of  Cattle,  278 
of  Horses,  752 
of  the  Dog,  8  28 
Vesicular,  of  Cattle,  278 
TumoTs  of  the  Dog,  82S 
Ventral    Hernia     (Interfering    with 

Fertility),  174 
Vesicles,  Seminal,  tlie    I^xainination 

of,  76 
Vesiculae  Scmiiiales,  Diseases  of,  in 
vStallions,  785 
Inflammation  of  (Bull),  389 
Prostate,  and  Cowper's  Glands, 
10 
\'esicular  Venereal  Disease  of  Cattle, 
278 
of  Horse,  766 
Vulva,  The,  41 

Ivxamination  of  the,  .S4 
Vulva,  Horizontal  (Interfering  with 
Coitus),  174 
Infections  of  the,  650 
Strictures  of,    175 
Vulvar  Diseases  in  Mare,  813 

Tuberculosis,  352 
White  Scours,  651" 
Withers,  Coiilusioiis  of,   from   Bites, 
219 


PUBLICATIONS  BY  W.  L.  WILLIAMS 

'Professor  of  Veterinary  Obstetrics  and  'Jlesearch 
T^rofessor  of  the  Diseases  of  Breeding  Cattle  in  the  New 
York  State   Veterinary    College    at    Cornell    University 


1 .  The  Diseases  of  the  Genital  Organs  of  Domestic  Animals. 

(With  the  collaboration  of  W.  W.  Williams,  B.A.,  D.V.M.) 
Published  1921,  Price  $10.00 

A  treatise  of  856  +  xviii  pages,  with  8  colored  eugavings  and 
over  240  illustrations  in  the  text,  nearly  all  original.  The  first 
effort  in  any  language  to  arrange  systematically  the  diseases 
of  the  genital  organs  of  animals,  and  to  deal  at  length  with  the 
diseases  causing  sterility,  abortion  and  other  interferences 
with  reproduction. 


2.  Veterinary  Obstetrics. 

637  +  xiv  pages,  with   3  colored   plates  and  140  illustrations 
in  the  text.     Published  1917 ,  Price  $^.00. 

Veteriiiary  Obstetrics  is  freely  recognized  as  the  highest  au- 
thority extant  in  this  field.  It  is  a  companion  volume  to  The 
Diseases  of  the  Genital  Organs  and  the  two  should  be  studied  in 
conjunction. 

Excerpts  from  Reviews  of  Veterinary  Obstetrics 
"Under  the  heading  of  maternal  dystocia,  we  have  the  most 
important  chapter  in  this  new  work.  Here  the  author  treats  the 
dystocia  of  contagious  abortion,  by  far  the  most  common  form  in 
the  cow.  It  is  a  clinical  fact  that  dystocia  of  cows  is  on  the 
increase,  and  that  the  majority  of  cases  are  easily  handled. 
They  are  caused  by  partially  dilated  cervix,  slight  deviations, 
dead  fetus,  weak  expulsive  power,  and  emphysema.  All  these 
trace  back  to  infection  of  the  uterus,  and  the  consequent  uterine 


inertia.  Non-dilation  of  the  cervical  canal,  or  induration  of  the 
cervix,  is  viewed  from  a  new  angle,  and  is  shown  to  be  uterine 
instead  of  cervical  in  the  majority  of  cases. 

The  discussion  of  uterine  inertia  is  highly  interesting  and 
throws  new  light  upon  the  ever-increasing  number  of  cases  of 
dystocia.  The  author's  conclusions  are  substantiated  by  clinical 
facts.  The  uterus  in  dystocia  of  contagious  abortion  is  easily 
contused  and  abraded,  with  resulting  infection  and  necrosis. 
The  author  might  have  pointed  out  still  more  emphatically  the 
results  of  severe  traction  and  forced  extraction  in  this  class  of 
dystocia. 

The  outstanding  feature  of  this  new  work  is  the  fact  that  the 
author  has  put  in  concrete  form  the  relation  between  uterine 
infection  and  dystocia  ;  he  has  pointed  out  that  the  obstetrist  is 
constantly  working  in  the  midst  of  a  virulent  infection. 

— /.  L.  Buchanan  in    The  Cornell  Veterinarian.'" 


"  So  comprehensive  a  work  can  only  be  reviewed  broadly  ;  and 
it  may  be  said  at  once  that  the  book,  while  containing  much  con- 
troversial matter,  will  be  very  valuable  to  all  veterinarians  prac- 
ticing in  breeding  districts.  The  author  often  challenges  gener- 
ally accepted  views  ;  but  when  his  controversial  opinions  are 
closely  examined,  it  will  be  found  that  .solid  rea.sons  are  adduced 
on  behalf  of  most  of  them.  The  book  possesses  two  outstanding 
merits.  The  first  is  the  attention  given  to  the  practical  details 
of  parturition  work,  of  the  difficulties  of  which  the  author  has 
evidently  had  great  experience. 

The  second  special  merit  of  the  book  is  its  constant  attempt  to 
trace  out  the  anatomical  and  physiological  causes  upon  which 
obstetric  troubles  depend  ;  and  here  the  practitioner  will  find  the 
work  exceedingly  stimulating  and  suggestive.  The  sections 
upon  such  hitherto  little-mentioned  subjects  as  rupture  of  the 
prepubian  tendon  and  bi-cornual  pregnancy  are  instances  of  this. 
In  this  connection  an  important  feature  of  the  work  is  its  insist- 
ence on  the  intimate  relation  between  disea.ses  of  the  genital 
organs  and  difficulties  in  parturition  ;  and  here  the  section  upon 
the  dystocia  of  contagious  abortion — the  latter  term  being  used 
in  its  widest  .sen.se  to  include  abortions  due  not  only  to  Bang's 


bacillus,  but  also  to  other  microbial  infections — is  perhaps  the 
best  example  of  the  trend  of  the  author's  teaching.  It  will  not 
be  universally  accepted  ;  but  no  one  will  be  able  to  read  the  book 
without  being  forced  to  re-examine  his  views  upon  many 
obstetric  questions. 

—  JJ'\  R.  C.  in  the   \'eterinary  Record,  Oct.  ^7,  ipij.'" 


"This  is  not  a  second  edition  of  Williams'  Veterinary 
Obstetrics  published  in  1909.  It  is  a  new  work  of  much 
more  manageable  proportions,  being  restricted  to  the  anatomy 
and  physiology  of  the  generative  organs,  normal  and  abnormal 
pregnancy,  parturition  and  dystocia,  traumatic  lesions  incidental 
to  parturition,  and,  lastly,  puerperal  laminitis  and  tetanus,  and 
certain  eclamptic  diseases.  .  .  .  The  point  (nomenclature 
of  positions)  is  of  little  importance  compared  with  what  Professor 
Williams  calls  the  "dystocia  of  contagious  abortion,"  which 
may  give  rise  to  some  misunderstanding,  suggesting  the  presence 
of  Bang's  bacillus.  On  the  contrary,  the  expression  is  used 
very  broadly  to  indicate  any  infection  which  invades  the  uterus, 
setting  up  a  chronic  metritis  and  imperilling  the  life  of  the 
foetus,  with  or  without  actual  abortion.  The  author  appears  to 
regard  any  ante-partum  infection  of  the  uterus  as  the  chief  cause 
of  both  maternal  and  foetal  dystocia  in  cows.  On  p.  426  we 
find,  "  formerly  it  was  said  that,  if  a  cow  suffered  from  dystocia, 
if  parturition  were  tardy,  she  would  probably  suffer  from  reten- 
tion of  the  foetal  membranes,  or  metritis  ;  now  it  may  be  said 
that,  if  metritis  exists  in  the  pregnant  cow,  perhaps  revealing  its 
presence  after  parturition  as  retained  afterbirth,  the  parturition 
will  be  tardy — there  will  be  dystocia."  Cause  and  effect  are 
thus  reversed.  ...  By  the  publication  of  this  treatise, 
which  promises  to  become  a  standard  work  on  both  sides  of  the 
Atlantic,  Professor  Williams  has  enhanced  his  reputation  as  an 
able  obstetrician  and  teacher. — A.   [K  171  the  Wteriyiary  Reviezv. 


"  In  view  of  the  large  field  of  usefulness  which  veterinary  ob- 
stetrics affords  for  the  young  practitioner,  it  is  apparent  that  a 
modern  work  on   the  subject  by  an  author  who  has  had  the  ad- 


vantage  of  man}-  years'  practical  experience,  as  well  as  devoting 
special  attention  to  the  scientific  aspect  of  obstetrical  knowledge, 
will  be  of  marked  value  to  the  profession.  A  perusal  of  the 
work  under  review  leads  us  to  the  conclusion  that  not  only  will 
it  prove  a  most  useful  and  instructive  text  book  for  the  student, 
but  it  will  supply  the  practitioner  with  a  most  valuable  manual 
for  reference  in  the  many  difficult  problems  which  are  so  fre- 
quently presented  in  the  practice  of  obstetrics. 
Finally,  we  may  remark  that  both  practitioners  and  students  of 
veterinary  medicine  are  under  a  deep  debt  of  gratitude  to  Profes- 
sor Williams  for  placing  within  their  reach  a  work  which  repre- 
sents not  only  all  that  is  known  on  the  subject,  but  also  the 
valuable  experiences  and  observations  of  a  master  of  the  art  and 
science  of  obstetrics,  written  in  a  concise  and  lucid  style,  leavened 
by  actual  practice,  and  not  compiled  from  the  works  of  other 
men  nor  founded  on  the  dreams  of  the  theorist  or  '  arm-chair  ' 
thinker." — E.  IVal/is Hoare,  iyithe  Veterinary  Neu's,  Jan.  5-,  igi8. 


"Those  who  know  the  keenness  with  which  Professor 
Williams  has  entered  into  research  in  connection  with  contagious 
abortion  will  expect  something  good  in  this  book,  and  they  will 
not  be  disappointed.  There  are  too  few  volumes  containing  a 
reasoned  and  practical  survey  of  the  field  of  obstetrics,  written 
by  scientists  with  wide  and  plentiful  technical  experience. 

The  man  in  a  busy  country  practice  who  has  time  to  read 
should  take  this  book  on  his  knee  in  his  spare  moments  and  read 
it  through  and  through.  However  good  an  obstetrist  he  may 
be,  he  will  find  fresh  tips,  live  understanding,  and  very  valuable 
information  in  this  work.  We  think  sometimes  that  an  intelli- 
gent understanding  of  the  state  of  affairs  in  a  pregnant  uterus  is 
of  more  value  to  the  obstetrist  than  a  mere  rough-and-ready 
overcoming  of  the  difficulty  presented.  This  book  tells  how  to 
accomplish  the  task  smoothly  and  effectively,  with  the  least 
injury  to  tlie  patient  and  the  greatest  benefit  to  the  new  arrival. 
We  wish  the  volume  every  success  ;  it  is  a  grand  one.  We  look 
forward  with  pleasure  to  a  t^ook  by  tliesanie  aiillior  on  "  Diseases 
of  the  Genital  Organs." 

—  Ci .  M.  ill  llif   \  'lirriiiary  /ournal . 


Surgical  and  Obstetrical  Operations. 

Fourth  revised  edition. 
(With  the  collaboration  of  J.  N.  Frost,  Professor  of  Surgery 

in    the    New   York    State  Veterinary  College  at    Cornell 

University.) 
196  +  X  pages,  with  74  illustrations. 
A    concise   treatise    upon    the   most    common    surgical   and 

obstetrical  operations,  designed  primarily  as  a  laboratory 

guide  for  students  and  as  a  compendium  for  practitioners. 

Price  $j  00. 


The  books  in  the  above  list  are  not  sold  to  dealers  at  a  discount 
and  should  be  ordered  direct  from  the  author. 


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